Provider Demographics
NPI:1538890785
Name:LITTLE, KYLE JOSEPH (PA-S)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 S KIMBALL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8200
Mailing Address - Country:US
Mailing Address - Phone:208-731-9753
Mailing Address - Fax:
Practice Address - Street 1:1924 S KIMBALL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8200
Practice Address - Country:US
Practice Address - Phone:208-731-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant