Provider Demographics
NPI:1760956387
Name:CRAVER, KYLE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LYNN
Last Name:CRAVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 ANTIOCH DR
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9267
Mailing Address - Country:US
Mailing Address - Phone:336-239-1464
Mailing Address - Fax:
Practice Address - Street 1:2874 S NC 127 HWY
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9131
Practice Address - Country:US
Practice Address - Phone:828-294-4100
Practice Address - Fax:800-951-8614
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7529171000000X, 363A00000X
NC001015267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider