Provider Demographics
NPI:1700813037
Name:PYLES-SWEET, KRIS T (PA-C)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:T
Last Name:PYLES-SWEET
Suffix:
Gender:F
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 1:12811 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-8606
Mailing Address - Country:US
Mailing Address - Phone:704-345-7508
Mailing Address - Fax:704-547-9515
Practice Address - Street 1:12811 MELISSA DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-8606
Practice Address - Country:US
Practice Address - Phone:704-345-7508
Practice Address - Fax:704-547-9515
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130JUMedicaid
NC89130JUMedicaid
NC2759408AMedicare ID - Type Unspecified
NC2759408CMedicare PIN