Provider Demographics
NPI:1982883856
Name:HARMER, KYLE W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:W
Last Name:HARMER
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 1:3181 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5610
Mailing Address - Country:US
Mailing Address - Phone:801-569-5520
Mailing Address - Fax:801-352-5951
Practice Address - Street 1:3181 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5610
Practice Address - Country:US
Practice Address - Phone:801-569-5520
Practice Address - Fax:801-352-5951
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5169398-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP67674Medicare UPIN
UT000012623Medicare PIN