Healthcare Provider Details

I. General information

NPI: 1063729804
Provider Name (Legal Business Name): KYLE FRANK HERSPRING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 GRANT ST
ATWOOD KS
67730-1526
US

IV. Provider business mailing address

707 GRANT ST
ATWOOD KS
67730-1526
US

V. Phone/Fax

Practice location:
  • Phone: 785-626-3211
  • Fax: 785-626-3188
Mailing address:
  • Phone: 785-626-3211
  • Fax: 785-626-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01394
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: