Healthcare Provider Details

I. General information

NPI: 1649793522
Provider Name (Legal Business Name): KYLE WILLIAM KRAFT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAINT MARYS DR STE 300
EVANSVILLE IN
47714-0521
US

IV. Provider business mailing address

901 SAINT MARYS DR STE 300
EVANSVILLE IN
47714-0521
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-2642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10002244A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10002244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: