Provider Demographics
NPI:1598061053
Name:KYLE, CHRISTOPHER DOUGLAS (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DOUGLAS
Last Name:KYLE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-664-7048
Practice Address - Fax:703-644-7402
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169251367500000X
MDR191518367500000X
CANA4420367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598061053Medicaid
FL011150500Medicaid
MD4225490Medicaid
MD4225490Medicaid