Provider Demographics
NPI:1710238266
Name:HERALD, KYLE ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALLEN
Last Name:HERALD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-780-2497
Mailing Address - Fax:270-783-0454
Practice Address - Street 1:1065 ASHLEY ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3400
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-780-0496
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTC144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical