Provider Demographics
NPI:1689194920
Name:BYRNE, KYLE D (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S DOBSON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6160
Mailing Address - Country:US
Mailing Address - Phone:480-962-8485
Mailing Address - Fax:480-962-4210
Practice Address - Street 1:1100 S DOBSON RD STE 203
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-962-8485
Practice Address - Fax:480-962-4210
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant