Healthcare Provider Details

I. General information

NPI: 1922337757
Provider Name (Legal Business Name): MEREDITH L KYLE RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 WEST NORTH ST
GENEVA NY
14456-1530
US

IV. Provider business mailing address

293 WEST NORTH ST
GENEVA NY
14456-1530
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-0993
  • Fax: 315-789-0281
Mailing address:
  • Phone: 315-789-0993
  • Fax: 315-789-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number013752-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013752-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: