Provider Demographics
NPI:1851848956
Name:MACHYNIA, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MACHYNIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5910
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-5910
Mailing Address - Country:US
Mailing Address - Phone:775-588-5000
Mailing Address - Fax:
Practice Address - Street 1:276 KINGSBURY GRADE
Practice Address - Street 2:SUITE 101
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-9804
Practice Address - Country:US
Practice Address - Phone:775-588-5000
Practice Address - Fax:775-588-5001
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1762363A00000X
FLPA9109733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant