Provider Demographics
NPI:1740824861
Name:MCGOVERN, KYLE TREVOR (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:TREVOR
Last Name:MCGOVERN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:95 SANDY FLAT RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-6367
Mailing Address - Country:US
Mailing Address - Phone:404-402-9824
Mailing Address - Fax:
Practice Address - Street 1:707 S GRADY WAY STE 600
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3227
Practice Address - Country:US
Practice Address - Phone:206-257-2987
Practice Address - Fax:206-309-3319
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-11-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant