Provider Demographics
NPI:1821645979
Name:ROBLES, KYLE P (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:P
Last Name:ROBLES
Suffix:
Gender:M
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-489-3554
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:PO BOX 421
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-0421
Practice Address - Country:US
Practice Address - Phone:509-293-5421
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61281714363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2169874Medicaid