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NPI Code Detail

MEDICARE: WYCLIFF KIPKEMOI PA-C

MEDICARE: WYCLIFF KIPKEMOI PA-C
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

General Provider Information

NPI Number : 1669260410
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYCLIFF KIPKEMOI PA-C
Provider Business Mailing Address
First Line : 300 COLLEGE PARK AVE
Second Line :
City : DAYTON
State : OH
Zip : 45469-0001
Country : US
Telephone Number : 937-229-1000
Fax Number :
Provider Business Practice Location Address
First Line : 300 COLLEGE PARK AVE
Second Line :
City : DAYTON
State : OH
Zip : 45469-0002
Country : US
Telephone Number : 937-229-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2025
Last Update Date : 04/30/2025

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Directions to “ WYCLIFF KIPKEMOI PA-C” Practice Location

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