Provider Demographics
NPI:1558754044
Name:HORTON-MASER, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HORTON-MASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 SPINDRIFT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7894
Mailing Address - Country:US
Mailing Address - Phone:716-831-2600
Mailing Address - Fax:716-831-2601
Practice Address - Street 1:297 SPINDRIFT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7894
Practice Address - Country:US
Practice Address - Phone:716-831-2600
Practice Address - Fax:716-831-2601
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339463-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner