Provider Demographics
NPI:1114699915
Name:OLSON, KYLE (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 102ND PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6602
Mailing Address - Country:US
Mailing Address - Phone:206-778-4810
Mailing Address - Fax:
Practice Address - Street 1:2121 W ELGIN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5608
Practice Address - Country:US
Practice Address - Phone:480-899-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant