MEDICARE: KYLER PRISK

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		MO

General Provider Information

NPI Number	:	1780542027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLER PRISK

Provider Business Mailing Address
First Line	:	3801 S NATIONAL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 S NEW BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8221
Country	:	US
Telephone Number	:	314-364-8318
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	03/13/2026

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Directions to “ KYLER PRISK ” Practice Location

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