Provider Demographics
NPI:1891737243
Name:NEVILLS, KYLE DALE (CRNA, DNP, NSPM-C)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DALE
Last Name:NEVILLS
Suffix:
Gender:M
Credentials:CRNA, DNP, NSPM-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HYLTON HEIGHTS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2812
Mailing Address - Country:US
Mailing Address - Phone:785-320-7576
Mailing Address - Fax:785-320-5428
Practice Address - Street 1:1213 HYLTON HEIGHTS RD STE 109
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-320-7576
Practice Address - Fax:785-320-5428
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54321163WP0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100248420CMedicaid