Provider Demographics
NPI:1609039825
Name:HOFFMANN, KYLE MARLIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MARLIN
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 W CARIBOU CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2699
Mailing Address - Country:US
Mailing Address - Phone:801-388-8412
Mailing Address - Fax:
Practice Address - Street 1:1221 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2829
Practice Address - Country:US
Practice Address - Phone:509-758-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4887336-1206363A00000X
WAPA61478061363A00000X
AZ4419363A00000X
MI5601011492363A00000X
NMPA2021-0078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant