Provider Demographics
NPI:1275916272
Name:MAURER, KYLIE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MAURER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:WOODLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1000
Mailing Address - Country:US
Mailing Address - Phone:712-335-5632
Mailing Address - Fax:
Practice Address - Street 1:608 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1000
Practice Address - Country:US
Practice Address - Phone:712-335-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant