Provider Demographics
NPI:1487046850
Name:PELLIGRA, KYLE GILMORE (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:GILMORE
Last Name:PELLIGRA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7228 PITTSBORO-MONCURE RD
Mailing Address - Street 2:
Mailing Address - City:MONCURE
Mailing Address - State:NC
Mailing Address - Zip Code:27559
Mailing Address - Country:US
Mailing Address - Phone:919-542-4991
Mailing Address - Fax:919-542-3726
Practice Address - Street 1:7228 PITTSBORO-MONCURE RD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559
Practice Address - Country:US
Practice Address - Phone:919-542-4991
Practice Address - Fax:919-542-3726
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05500363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical