Individual
KYLE ROTHERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8005 FARNAM DR STE 305, OMAHA, NE 68114-3426
(402) 390-4111
(402) 390-4115
Mailing address
8005 FARNAM DR STE 305, OMAHA, NE 68114-3426
(402) 390-4111
(402) 390-4115
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
118173
IA
363A00000X
Physician Assistant
1204103
NE
363A00000X
Physician Assistant
2867
NE
363AS0400X
Surgical Physician Assistant
Primary
2867
NE
Other
Enumeration date
01/02/2023
Last updated
10/30/2025
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