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General NPI Number Information
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NPI Number | 1295331791
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Entity Type | Individual
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Provider Name | KYLE MICHAEL SUTHERLAND PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 531 HANNAH ST
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City | CLEARFIELD
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State | PA
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Zip | 16830-1245
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Country | US
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Telephone | 814-765-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 235 HARRIS AVE
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City | BOALSBURG
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State | PA
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Zip | 16827-1239
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Country | US
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Telephone | 814-409-8652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1171989
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License Number State | PA
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