Provider Demographics
NPI:1306814892
Name:CALYER, KEVIN C (RPA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:CALYER
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-773-5559
Mailing Address - Fax:518-773-5601
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-773-5559
Practice Address - Fax:518-773-5601
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000411536002OtherBSH NE NY
NY387545OtherMVP HEALTHPLAN
NY000411536002OtherBSH NE NY
NYQ06370Medicare UPIN