Provider Demographics
NPI:1669993945
Name:KLINE, SKYLAR ARIEL (PA-C)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:ARIEL
Last Name:KLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:ARIEL
Other - Last Name:FRISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 HERRICK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2796
Mailing Address - Country:US
Mailing Address - Phone:978-927-3040
Mailing Address - Fax:978-927-0443
Practice Address - Street 1:77 HERRICK ST STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2796
Practice Address - Country:US
Practice Address - Phone:978-927-3040
Practice Address - Fax:978-927-0443
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA6502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant