Provider Demographics
NPI:1336564566
Name:BROWN, KYLE ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2284
Mailing Address - Country:US
Mailing Address - Phone:308-254-9192
Mailing Address - Fax:308-254-9750
Practice Address - Street 1:830 PINE ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2284
Practice Address - Country:US
Practice Address - Phone:308-254-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant