Individual
KYLE FETTEROLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
423 3RD AVE STE B, KINGSTON, PA 18704-5809
(570) 288-3601
(570) 288-1726
Mailing address
423 3RD AVE STE B, KINGSTON, PA 18704-5809
(570) 288-3601
(570) 288-1726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001889L
PA
Other
Enumeration date
02/28/2006
Last updated
02/13/2025
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