Healthcare Provider Details

I. General information

NPI: 1609039825
Provider Name (Legal Business Name): KYLE MARLIN HOFFMANN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 HIGHLAND AVE
CLARKSTON WA
99403-2829
US

IV. Provider business mailing address

1107 W CARIBOU CT
PLEASANT VIEW UT
84414-2699
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-5511
  • Fax:
Mailing address:
  • Phone: 801-388-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4887336-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61478061
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4419
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011492
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2021-0078
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: