Provider Demographics
NPI:1538694468
Name:KAY, TYSON KYLE (PA)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:KYLE
Last Name:KAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8154
Mailing Address - Country:US
Mailing Address - Phone:575-532-5455
Mailing Address - Fax:
Practice Address - Street 1:1106 CENTRE CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8154
Practice Address - Country:US
Practice Address - Phone:575-532-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant