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General NPI Number Information
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NPI Number | 1477807105
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Entity Type | Individual
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Provider Name | KYLIE HARROLD PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-0001
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Country | US
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Telephone | 608-262-5420
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Fax | 608-262-5624
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone | 608-829-5485
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Fax | 608-833-0999
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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 | 3564-23
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License Number State | WI
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