Provider Demographics
NPI:1811474406
Name:MCNERLIN, KYLIE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MCNERLIN
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 1:620 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1722
Mailing Address - Country:US
Mailing Address - Phone:814-643-0309
Mailing Address - Fax:
Practice Address - Street 1:835 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1725
Practice Address - Country:US
Practice Address - Phone:814-506-8114
Practice Address - Fax:814-506-8553
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3632084P0800X, 208D00000X
PAMA059949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103540556Medicaid