Provider Demographics
NPI:1720830904
Name:WEISS, KYLE ANDREW (CNP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:WEISS
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 CALLE DEL SOL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1909
Mailing Address - Country:US
Mailing Address - Phone:408-781-0505
Mailing Address - Fax:
Practice Address - Street 1:7200 MONTGOMERY BLVD NE STE 7121
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1510
Practice Address - Country:US
Practice Address - Phone:408-781-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78510363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty