Basic Information
| Provider Information | |||||||||
| NPI: | 1932554474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KYLE | ||||||||
| FirstName: | ADAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6129 CHIDESTER DR | ||||||||
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| City: | CANFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444069749 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1995 E STATE ST | ||||||||
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| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303321551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2016 | ||||||||
| LastUpdateDate: | 05/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | COA.18913-NA | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.