Provider Demographics
NPI:1972001519
Name:KNOWLES, KYLE JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 N BLUE BELL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 EAST CHESTNUT AVENUE
Practice Address - Street 2:BUILDING 8 SUITE B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-507-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00456000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant