NPI 1306539440 · live from the CMS NPI Registry
Kylee Black
Physician Assistant in Fort Myers, FL. National Provider Identifier 1306539440, active.
NPI record
| NPI | 1306539440 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 9800 S Healthpark Dr Ste 110, Fort Myers, FL 33908 |
| Practice phone | 239-343-6202 |
| Mailing address | 4957 13k St Nw, Garrison, ND 58540 |
| Enumerated | June 2, 2023 |
| Last updated | July 14, 2023 |
| Sole proprietor | Yes |
| Other names | Kylee Altendorf |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | — |
| Physician Assistant primary | 363A00000X | PA9117571 (FL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.