Provider Demographics
NPI:1659064350
Name:THOMAS, KYLE R (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:THOMAS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:100 S FIRST STREET
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1501
Practice Address - Country:US
Practice Address - Phone:717-692-4834
Practice Address - Fax:717-692-3678
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
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Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty