KYLIE BROUGHAL (NPI# 1326525270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
022166 | NY | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
6119 ST HWY RT 11 ST LAWRENCE MEDICAL OFFICE COMPLEX |
City | CANTON |
State | NY |
Zip Code | 13617 |
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 Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
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 |
Please comment or provide details below to improve the information on KYLIE BROUGHAL.
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.