Individual
KYLE FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-8515
(508) 334-6490
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9554
MA
363AM0700X
Medical Physician Assistant
PA9120161
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127271600
—
FL
01
—
HJU2H
BCBS
FL
Enumeration date
08/03/2023
Last updated
12/07/2025
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