Healthcare Provider Details

I. General information

NPI: 1740902402
Provider Name (Legal Business Name): KYLER STEVEN HORNEWER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5600
  • Fax: 919-863-6821
Mailing address:
  • Phone: 919-781-5600
  • Fax: 919-863-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001012594
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: