Individual
DR. TYSON RAND KINNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PBT(ASCP), PHD, PA-C
Contact information
Practice address
128 MARKET ST, ALAMOSA, CO 81101-2290
(719) 587-1001
Mailing address
5647 US HIGHWAY 26, DUBOIS, WY 82513-9607
(307) 455-2516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002413
IA
363A00000X
Physician Assistant
Primary
PA.0008078
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881019925
NPI NUMBER
—
01
—
986
WY LICENSE NUMBER
WY
Enumeration date
02/26/2014
Last updated
01/18/2024
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