Provider Demographics
NPI:1063729804
Name:HERSPRING, KYLE FRANK (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:FRANK
Last Name:HERSPRING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:707 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-1526
Mailing Address - Country:US
Mailing Address - Phone:785-626-3211
Mailing Address - Fax:785-626-3188
Practice Address - Street 1:707 GRANT ST
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1526
Practice Address - Country:US
Practice Address - Phone:785-626-3211
Practice Address - Fax:785-626-3188
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant