Healthcare Provider Details

I. General information

NPI: 1598686859
Provider Name (Legal Business Name): KYLIE DOMANGUE SAVAGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 BAYOU BLVD
PENSACOLA FL
32503-2601
US

IV. Provider business mailing address

5814 RAWSON LN
PENSACOLA FL
32503-7733
US

V. Phone/Fax

Practice location:
  • Phone: 985-860-4684
  • Fax:
Mailing address:
  • Phone: 985-860-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: