Provider Demographics
NPI:1962071340
Name:VOGEL, KYLER (PA-C)
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:KYLER
Other - Middle Name:
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:209 IRISH CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3634
Mailing Address - Country:US
Mailing Address - Phone:423-869-5600
Mailing Address - Fax:
Practice Address - Street 1:209 IRISH CEMETERY RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3634
Practice Address - Country:US
Practice Address - Phone:423-869-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant