Provider Demographics
NPI:1841026283
Name:POPPELL, KYLIE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:POPPELL
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 DR CALVIN JONES HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3108
Mailing Address - Country:US
Mailing Address - Phone:919-761-5678
Mailing Address - Fax:
Practice Address - Street 1:620 DR CALVIN JONES HWY STE 212
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3108
Practice Address - Country:US
Practice Address - Phone:919-761-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant