Most Relevant Information
Provider Data
| NPI Number: | 1003467747 |
| Provider Name: | KYLE NICK PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/24/2019 |
| Last Updated: | 09/24/2019 |
Provider Practice Location
1 ATWELL RD
COOPERSTOWN
NY
133261301
Practice Location Phone/Fax
| Phone: | 6075473456 |
| Fax: |
Provider Mailing Location
1 ATWELL RD
COOPERSTOWN
NY
133261301
Provider Mailing Phone/Fax
| Phone: | 6075473456 |
| Fax: |