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Individual
KYLE J CHRISTENSEN
Active
Individual
KYLE J CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
NULL
363AS0400X
Surgical Physician Assistant
PA2006-0022
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47589523
—
NM
01
—
PA2006-0022
MEDICAL LICENSE
NM
Enumeration date
09/25/2006
Last updated
06/24/2022
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