Individual
KYLE FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
610 W MAIN ST, WILMINGTON, OH 45177-2125
(937) 382-6611
Mailing address
610 W MAIN ST, WILMINGTON, OH 45177-2125
(740) 606-2119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/09/2016
Last updated
09/09/2016
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