Provider Demographics
NPI:1609039825
Name:HOFFMANN, KYLE MARLIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MARLIN
Last Name:HOFFMANN
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 1:1600 W ANTELOPE DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1142
Mailing Address - Country:US
Mailing Address - Phone:801-807-7177
Mailing Address - Fax:
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1142
Practice Address - Country:US
Practice Address - Phone:801-807-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4887336-1206363A00000X
NMPA2021-0078363A00000X
AZ4419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant