Provider Demographics
NPI:1124662028
Name:MOTSENBOCKER, KYLE DAVID (FNP-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:MOTSENBOCKER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CEDAR CREEK LN APT 1226
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2110
Mailing Address - Country:US
Mailing Address - Phone:940-284-3212
Mailing Address - Fax:
Practice Address - Street 1:2700 CEDAR CREEK LN APT 1226
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2110
Practice Address - Country:US
Practice Address - Phone:940-284-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10190965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX862777OtherBOARD OF NURSING
TXF10190965OtherAANP-FNP CERTIFICATION