Provider Demographics
NPI:1831675545
Name:MCLAFFERTY, KYLE PATRICK (PA)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:PATRICK
Last Name:MCLAFFERTY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO2018025495363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220061872Medicaid