Healthcare Provider Details

I. General information

NPI: 1366353658
Provider Name (Legal Business Name): KYLA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLA OBRIEN

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 EASTERN BLVD
YORK PA
17402-2917
US

IV. Provider business mailing address

220 FORRESTER RD
SLIPPERY ROCK PA
16057-2518
US

V. Phone/Fax

Practice location:
  • Phone: 717-840-2730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: