Individual
MR. KYLE AARON CONROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC/L
Contact information
Practice address
2325 DOUGHERTY FERRY RD, STE 100, SAINT LOUIS, MO 63122-3356
(314) 909-1359
Mailing address
2325 DOUGHERTY FERRY RD, STE 100, SAINT LOUIS, MO 63122-3356
(314) 909-1359
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096.002251
IL
363A00000X
Physician Assistant
085004280
IL
363A00000X
Physician Assistant
Primary
2012013844
MO
Other
Enumeration date
03/09/2006
Last updated
05/04/2012
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