Provider Demographics
NPI:1407335094
Name:KNIES, KYLA K (PA)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:K
Last Name:KNIES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:K
Other - Last Name:ALTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-464-9133
Mailing Address - Fax:812-464-0559
Practice Address - Street 1:520 MARY ST STE 230
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1678
Practice Address - Country:US
Practice Address - Phone:812-464-9133
Practice Address - Fax:812-464-0559
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002568A363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical