MEDICARE: KYLE ANDERSON PA

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
1	363A00000X	Physician Assistant	14267947-1206	UT
2	363A00000X	Physician Assistant	PA2376	NV

General Provider Information

NPI Number	:	1508459231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ANDERSON PA

Provider Business Mailing Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	702-240-8646
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	702-240-8646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2021
Last Update Date	:	02/06/2026

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Directions to “ KYLE ANDERSON PA” Practice Location

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