Provider Demographics
NPI:1730331711
Name:DENNY, KYLE A (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:A
Last Name:DENNY
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 1:400 S KENNEDY DR STE 700
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2639
Mailing Address - Country:US
Mailing Address - Phone:815-935-7532
Mailing Address - Fax:815-933-7495
Practice Address - Street 1:400 S KENNEDY DR STE 700
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2639
Practice Address - Country:US
Practice Address - Phone:815-935-7532
Practice Address - Fax:815-933-7495
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant