Provider Demographics
NPI:1780116129
Name:VOGEL, KYLIE RHEA (PA)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:RHEA
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:8462 HUNNICUT RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5935
Mailing Address - Country:US
Mailing Address - Phone:214-205-6435
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILLION III, SUITE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10906363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical