Healthcare Provider Details

I. General information

NPI: 1750218657
Provider Name (Legal Business Name): MR. KYLE RENNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EXPEDITION TRL STE 203
GETTYSBURG PA
17325-8599
US

IV. Provider business mailing address

20 EXPEDITION TRL STE 203
GETTYSBURG PA
17325-8599
US

V. Phone/Fax

Practice location:
  • Phone: 717-334-9535
  • Fax:
Mailing address:
  • Phone: 717-334-9535
  • Fax: 717-337-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007804
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA067978
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: