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General NPI Number Information
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NPI Number | 1407335094
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Entity Type | Individual
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Provider Name | KYLA K KNIES PA
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 520 MARY ST STE 230
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City | EVANSVILLE
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State | IN
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Zip | 47710-1678
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Country | US
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Telephone | 812-464-9133
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Fax | 812-464-0559
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Provider Business Mailing Address
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Address Line | PO BOX 1230
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City | EVANSVILLE
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State | IN
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Zip | 47706-1230
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Country | US
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Telephone | 812-464-9133
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Fax | 812-464-0559
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10002568A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002568A
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License Number State | IN
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