Individual
KYLE DAVID BRINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2525 W UNIVERSITY AVE STE 300, MUNCIE, IN 47303-3432
(765) 747-3883
(765) 448-7671
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002154A
IN
363AS0400X
Surgical Physician Assistant
10002154A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300005066
—
IN
01
—
M122404002
MEDICARE PTAN
IN
Enumeration date
08/12/2016
Last updated
07/08/2024
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