Provider Demographics
NPI:1245295252
Name:PYLE, PATRICIA K (CFNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:PYLE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4568
Mailing Address - Country:US
Mailing Address - Phone:765-674-3321
Mailing Address - Fax:765-677-6124
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:765-677-6124
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704209526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4626222Medicaid
500A710160OtherBCBS
MI4545732Medicaid
MI4626222Medicaid
R92892Medicare UPIN