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NPI Code Detail

MEDICARE: KYRA BRAUN PHYSICIAN ASSISTANT

MEDICARE: KYRA BRAUN PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician AssistantPAO1232RI
3363AM0700XMedical Physician AssistantMA063521PA

General Provider Information

NPI Number : 1174147698
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYRA BRAUN PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 569 W LANCASTER AVE
Second Line :
City : HAVERFORD
State : PA
Zip : 19041-1416
Country : US
Telephone Number : 610-525-5250
Fax Number : 610-525-2335
Provider Business Practice Location Address
First Line : 1516 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4409
Country : US
Telephone Number : 610-525-5250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2020
Last Update Date : 01/30/2024

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