Provider Demographics
NPI:1750990461
Name:ISAACS, KYRA (PA-C)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:ISAACS
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 1:1901 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4320
Mailing Address - Country:US
Mailing Address - Phone:302-743-6621
Mailing Address - Fax:
Practice Address - Street 1:1901 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4320
Practice Address - Country:US
Practice Address - Phone:302-743-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant