Provider Demographics
NPI:1942772249
Name:PFEIFER, KYLE EDWIN (MS, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EDWIN
Last Name:PFEIFER
Suffix:
Gender:M
Credentials:MS, APRN, NP-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4277
Mailing Address - Fax:615-891-5244
Practice Address - Street 1:69 S TERRACE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1355
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-1433
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329499Medicaid