Provider Demographics
NPI:1790290823
Name:STORNES, KYLEE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:MARIE
Last Name:STORNES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:MARIE
Other - Last Name:TUCHFARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:950 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7507
Mailing Address - Country:US
Mailing Address - Phone:740-586-6828
Mailing Address - Fax:
Practice Address - Street 1:950 BETHESDA DR BLDG 5
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-586-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant