Provider Demographics
NPI:1760011829
Name:HOLST, KYLE DAVID (CARC, CRPA, NYCPS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:HOLST
Suffix:
Gender:M
Credentials:CARC, CRPA, NYCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DELL ST # 3
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2101
Mailing Address - Country:US
Mailing Address - Phone:315-569-2358
Mailing Address - Fax:
Practice Address - Street 1:321 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3207
Practice Address - Country:US
Practice Address - Phone:315-569-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist