Provider Demographics
NPI:1770133654
Name:STEIBER, GARRETT KYLE (PA-C)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:KYLE
Last Name:STEIBER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-6005
Mailing Address - Fax:704-316-6006
Practice Address - Street 1:449 N WENDOVER RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1064
Practice Address - Country:US
Practice Address - Phone:704-316-6005
Practice Address - Fax:704-316-6006
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061022363A00000X
NC0010-13032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant