Provider Demographics
NPI:1457012908
Name:KINDER, KYLE L (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:L
Last Name:KINDER
Suffix:
Gender:
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-636-4900
Mailing Address - Fax:502-636-4901
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 430
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-4900
Practice Address - Fax:502-636-4901
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023009776363A00000X, 363A00000X
KYTC159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant