Provider Demographics
NPI:1508679481
Name:SUDHOFF, KYLER BRIDGEMAN
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:BRIDGEMAN
Last Name:SUDHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BOONE HEIGHTS DR # A
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4926
Mailing Address - Country:US
Mailing Address - Phone:828-386-2663
Mailing Address - Fax:
Practice Address - Street 1:232 BOONE HEIGHTS DR # A
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4926
Practice Address - Country:US
Practice Address - Phone:828-386-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant