Provider Demographics
NPI:1194451377
Name:GINNATY, KYLE THOMAS (PA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:THOMAS
Last Name:GINNATY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 ASHBROOK DR # 306
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3442
Mailing Address - Country:US
Mailing Address - Phone:402-680-2190
Mailing Address - Fax:
Practice Address - Street 1:1336 W A ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1231
Practice Address - Country:US
Practice Address - Phone:402-438-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant