Provider Demographics
NPI:1528711108
Name:EGNATUK, KYLEIGH CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:CHRISTINE
Last Name:EGNATUK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4024 PARK EAST CT SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8810
Mailing Address - Country:US
Mailing Address - Phone:616-975-1186
Mailing Address - Fax:
Practice Address - Street 1:4024 PARK EAST CT SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8810
Practice Address - Country:US
Practice Address - Phone:616-975-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant