KYLIE BROUGHAL


Address: 6119 St Hwy Rt 11, St Lawrence Medical Office Complex, Canton, NY 13617
Phone: 3152653300

KYLIE BROUGHAL (NPI# 1326525270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1326525270
Entity Type Individual
Full Name KYLIE BROUGHAL
Credential PA
Practice Address 6119 St Hwy Rt 11
St Lawrence Medical Office Complex
Canton
NY 13617
Mailing Address 50 Leroy St
Potsdam
NY 13676-1786
Practice Telephone 3152653300
Enumeration Date 2018-07-24
Last Update Date 2018-07-24
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
022166 NY Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 6119 ST HWY RT 11
ST LAWRENCE MEDICAL OFFICE COMPLEX
City CANTON
State NY
Zip Code 13617

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1700428802 Meagan Elizabeth Hogan Physician Assistant 6119 Us Highway Route 11, Canton, NY 13617 2019-10-10
1982251740 Wilma J. Blackmer Technician 1756 Cr 14, Canton, NY 13617 2019-08-26
1891299608 Sheena Teresa Smith Counselor 310 State Highway 310, Suite 1, Canton, NY 13617 2018-03-19
1972024594 Patrick James Sullivan Physician Assistant 6619 State Highway Route 11, Canton, NY 13617 2017-07-05
1225482763 Howard Orthotics and Prosthetics, LLC Prosthetic/Orthotic Supplier 6128 Us Highway11, Canton, NY 13617 2016-04-21
1831534452 Chin Hung Ho Dermatology 6119 State Highway Rt 11, Cph Dermotology, Canton, NY 13617 2013-05-09
1194061663 Sarah Prairie Counselor 80 State Hwy 310, Suite 1, Canton, NY 13617 2013-01-02
1679859094 Nathan Ellis Occupational Therapist 139 Outer State St. Rd, Canton, NY 13617 2011-10-31
1407139017 Julianne Rutley Occupational Therapist 139 Outer State Street Rd, Canton, NY 13617 2011-09-21
1780967224 Kathleen W Doyle Occupational Therapy Assistant 139 Outer State Street Rd., Canton, NY 13617 2011-09-21
Find all providers in zip 13617

Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1740684083 Nemi Thakker Physician Assistant 1351 Centennial Ct, Canton, MI 48187-5805 2014-10-15
1093047474 Kirby Brown Reinecke Physician Assistant 120 Oakside Ct, Suite H, Canton, GA 30114-2471 2010-02-09
1578784013 Aimee M Mitchell Physician Assistant 130 Oakside Court, Ste A Marietta Dermatology Associates Pa, Canton, GA 30114 2007-05-01
1447390315 Morgan P Bowler Physician Assistant 460 Northside Cherokee Blvd Ste 450, Canton, GA 30115-8020 2007-02-08
1821052440 James Willard Gilson Physician Assistant 6200 N Haggerty Rd, Canton, MI 48187 2006-04-12
1134188105 Eddy Toussaint Physician Assistant 460 Northside Cherokee Blvd Ste 100, Canton, GA 30115-8017 2006-03-20
1255330098 Stephen P Hinman Physician Assistant 205 State Street Road, Canton, NY 13617 2005-07-14
1467458612 Barbara Jo Bizub Physician Assistant 4535 Dressler Rd Nw, Canton, OH 44718-2545 2005-06-22
1518521145 Gabriel Martin Ibarra Physician Assistant 112 Southlake Cir, Canton, MS 39046-5368 2019-04-29
1962921643 Cameron Hord Physician Assistant 5154 Fulton Dr Nw, Canton, OH 44718-2365 2017-09-14
Find all providers in CANTON

Competitor

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City CANTON
Zip Code 13617

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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