Provider Demographics
NPI:1558740324
Name:HARLAN, KYLE (AA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HARLAN
Suffix:
Gender:M
Credentials:AA-C
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Mailing Address - Street 1:1000 E PRIMROSE ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5154
Mailing Address - Country:US
Mailing Address - Phone:417-269-4550
Mailing Address - Fax:417-269-4558
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-6000
Practice Address - Fax:417-269-4558
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-05-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant