Basic Information
| Provider Information | |||||||||
| NPI: | 1740902402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNEWER | ||||||||
| FirstName: | KYLER | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 LEGACY CT APT 147 | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285905111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232057636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 503 BOWMAN GRAY DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278347286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528164001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.