Provider Demographics
NPI:1740902402
Name:HORNEWER, KYLER STEVEN (PA-C)
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:STEVEN
Last Name:HORNEWER
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:624 LEGACY CT APT 147
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5111
Mailing Address - Country:US
Mailing Address - Phone:623-205-7636
Mailing Address - Fax:
Practice Address - Street 1:503 BOWMAN GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7286
Practice Address - Country:US
Practice Address - Phone:252-816-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-10-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant