Russell, Kyle A

Russell, Kyle A is an individual health care provider with primary practice located at 6 West Airport Road , Lititz PA 17543. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Russell, Kyle A can be contacted via phone (717) 627-2108.

Contact Information

Primary practice address
6 West Airport Road Lititz PA 17543
Phone: (717) 627-2108
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X OA002311 Pennsylvania
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X MA053822 Pennsylvania

Profile Details

NPI number 1164677969
LBN Legal business name Russell, Kyle A
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 20th, 2008
Last updated Nov 29th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164677969 NPPES
Pennsylvania Other P00667984 MEDICARE RAILROAD

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