Provider Demographics
NPI:1598364473
Name:PERSING, KYLEE N (PA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:N
Last Name:PERSING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SMITH AVE N STE 600
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2446
Mailing Address - Country:US
Mailing Address - Phone:651-565-1448
Mailing Address - Fax:
Practice Address - Street 1:280 SMITH AVE N STE 600
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2446
Practice Address - Country:US
Practice Address - Phone:651-565-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant