Provider Demographics
NPI:1790094449
Name:ZEHR, KYLE E (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:E
Last Name:ZEHR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:218 FOUST ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5476
Mailing Address - Country:US
Mailing Address - Phone:336-625-2333
Mailing Address - Fax:336-625-5511
Practice Address - Street 1:138 DUBLIN SQUARE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8600
Practice Address - Country:US
Practice Address - Phone:336-626-2688
Practice Address - Fax:336-626-4100
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054601363AM0700X
NC0010-03710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790094449Medicaid
NC1790094449Medicaid