KYLE R CLARK


Address: 5666 E State St, Rockford, IL 61108-2425
Phone: 8152262000

KYLE R CLARK (NPI# 1801415864) 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) 1801415864
Entity Type Individual
Full Name KYLE R CLARK
Credential PA-C
Practice Address 5666 E State St
Rockford
IL 61108-2425
Mailing Address 1395 Jay St
Freeport
IL 61032-8424
Practice Telephone 8152262000
Mailing Telephone 8152914052
Enumeration Date 2020-04-10
Last Update Date 2020-04-10
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 085.007488 IL Physician Assistants & Advanced Practice Nursing Providers

Other Providers KYLE CLARK

NPI Name Taxonomy Address Enumeration
1336787902 Kyle Clark Acupuncturist 917 Sw Oak St Ste 308, Portland, OR 97205-2806 2019-12-13
1891955662 Kyle Warner Clark Dentist 1008 Rushleigh Rd, Cleveland Heights, OH 44121-1415 2008-06-14
1922608926 Kyle Clark Pharmacist 401 Linwood Plz, Lindsay, OK 73052-4602 2020-10-28
1427669480 Kyle Clark Behavior Technician 1300 Locust St Ste C, Harrisonville, MO 64701-1366 2020-08-13
1750906533 Kyle Clark Behavior Technician 13101 W Washington Blvd, Los Angeles, CA 90066-5131 2020-06-08
1376170613 Kyle Clark Physical Therapist 3155 N Point Pkwy, Alpharetta, GA 30005-5481 2020-03-26
1669031829 Kyle N Clark Behavior Technician 100 Spenryn Dr, Madison, AL 35758-1890 2019-06-11
1588134068 Kyle Clark Behavior Technician 601 University Ave Ste 175, Sacramento, CA 95825-6739 2018-11-28
1639521206 Kyle Allen Clark Dentist 113 Cross Creek Blvd, Salem, IL 62881-1921 2016-07-07
1679946057 Kyle Clark Pharmacist 3780 E 15th St, Loveland, CO 80538-8766 2015-11-05

Office Location

Street Address 5666 E STATE ST
City ROCKFORD
State IL
Zip Code 61108-2425

Providers in the same location

NPI Name Taxonomy Address Enumeration
1508849209 Richard Emery Freeman Neurological Surgery 5666 E State St, Rockford, IL 61108-2425 2005-11-28
1881293348 Salman Nafees Nurse Anesthetist, Certified Registered 5666 E State St, Rockford, IL 61108-2425 2020-10-25
1346856424 Keely K Zunker Nurse Practitioner 5666 E State St, Rockford, IL 61108-2472 2020-09-23
1962026476 Angie Youssef Hernandez Student in an Organized Health Care Education/Training Program 5666 E State St, Rockford, IL 61108-2425 2020-06-01
1568085710 Kelsey Surowiec Student in an Organized Health Care Education/Training Program 5666 E State St, Rockford, IL 61108-2425 2020-05-22
1508495144 Sadie Jae Pierce-mulligan 5666 E State St, Rockford, IL 61108-2425 2020-04-06
1376170183 Nicole Ann O'neill Dietitian, Registered 5666 E State St, Rockford, IL 61108-2425 2020-03-24
1447884804 Marissa Ann Giannangeli Occupational Therapist 5666 E State St, Rockford, IL 61108-2425 2020-02-25
1023659711 Erin R. Moody Physician Assistant 5666 E State St, Rockford, IL 61108-2425 2019-10-03
1750941357 Deanna Lynn Berg Nurse Practitioner 5666 E State St, Rockford, IL 61108-2425 2019-06-17
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1952862617 Isr Enterprises, Inc. Homemaker 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 2019-03-26
1003306465 Adrienne Nicole Black Behavior Technician 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 2018-05-11
1184085201 Integrative Healing Center, LLC Clinic/Center 6019 Fincham Drive, Rockford, IL 61108 2016-03-17
1730547936 Perryville Dentist PC Dentist 845 S Perryville Rd, Unit 119, Rockford, IL 61108 2016-02-02
1023489853 Nicole Ping Ticknor Counselor 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 2015-10-20
1275940348 Northwest Home Care, Inc. Home Health 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 2014-07-21
1487072922 Alecia Greenlee Psychiatry & Neurology Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 2014-04-02
1871925446 Maria Laura Gustafson Interpreter 3208 Wesleyan Ave., Rockford, IL 61108 2013-08-06
1346582822 Joseph Peevey Pathology 5666 E State Street, Department of Pathology, Rockford, IL 61108 2013-03-21
1134466923 James Henry Peck Hearing Instrument Specialist 2424 Charles St, Rockford, IL 61108 2013-01-14
Find all providers in zip 61108

Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1871063776 Amira Al-basha Physician Assistant 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 2018-12-04
1578042982 Alyssa Margaret Vasylyuk Physician Assistant 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 2018-08-08
1053778456 Jamie Anticevich Physician Assistant 6595 East State Street, Rockford, IL 61108-2542 2016-01-15
1437534666 Irene Dyer Physician Assistant 1560 Red Oak Ln, Rockford, IL 61107-2767 2015-07-29
1215250675 Krista R Mohamed Physician Assistant 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 2010-03-12
1629121009 Jason A. Kadar Physician Assistant 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 2007-01-19
1295805851 Kristin Lynn King-shank Physician Assistant 171 Dogwood Dr Ne, Rockford, MI 49341-7361 2006-11-09
1245263268 William John Stout Physician Assistant 1401 E State Street, Rockford, IL 61104 2006-07-10
1952356040 Saint Anthony Medical Center Physician Assistant 6830 Villagreen Vw, Rockford, IL 61107-5639 2006-05-24
1972552131 Andrea B Fulcomer Physician Assistant 2404 Charles St, Rockford, IL 61108-1602 2006-05-08
Find all providers in ROCKFORD

Competitor

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City ROCKFORD
Zip Code 61108

Improve Information

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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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