Healthcare Provider Details

I. General information

NPI: 1952855405
Provider Name (Legal Business Name): KYLE DAVID BRINSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W UNIVERSITY AVE STE 300
MUNCIE IN
47303-3432
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-3883
  • Fax: 765-448-7671
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002154A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10002154A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: