Provider Demographics
NPI:1568786838
Name:KRABER, KYLE JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOHN
Last Name:KRABER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1266
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:8240 NAAB RD STE 220
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1986
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-876-2320
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001575A363A00000X
TXPA04676363A00000X
CO3196363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000842922OtherANTHEM
IN1487680518OtherGROUP NPI
IN000000842922OtherANTHEM