Healthcare Provider Details

I. General information

NPI: 1073347159
Provider Name (Legal Business Name): KYLER PATRICK PILEWSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST
WAKE FOREST NC
27587-1652
US

IV. Provider business mailing address

PO BOX 803854
KANSAS CITY MO
64180-3854
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-0365
  • Fax:
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14968
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: