Provider Demographics
NPI:1922337757
Name:KYLE, MEREDITH L (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:L
Last Name:KYLE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 WEST NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1530
Mailing Address - Country:US
Mailing Address - Phone:315-789-0993
Mailing Address - Fax:315-789-0281
Practice Address - Street 1:293 WEST NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1530
Practice Address - Country:US
Practice Address - Phone:315-789-0993
Practice Address - Fax:315-789-0281
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013752-1363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400013254Medicare PIN
J400013254Medicare UPIN