Provider Demographics
NPI:1316913221
Name:TERRY, KYLE ROWLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ROWLEY
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:WAITSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:99361-0247
Mailing Address - Country:US
Mailing Address - Phone:509-337-6311
Mailing Address - Fax:509-337-6011
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAITSBURG
Practice Address - State:WA
Practice Address - Zip Code:99361-9734
Practice Address - Country:US
Practice Address - Phone:509-337-6311
Practice Address - Fax:509-337-6011
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60153761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G553020Medicaid
ZZZ31675ZMedicare PIN
CAE57847Medicare UPIN
CA00G553020Medicaid