Provider Demographics
NPI:1194292714
Name:HISEY, KAYLE (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:KAYLE
Middle Name:
Last Name:HISEY
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 PEAK ONE DRIVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-477-4451
Mailing Address - Fax:970-477-7408
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-477-4451
Practice Address - Fax:970-477-7408
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty