KYLE J. SMISEK (NPI# 1336653864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336653864 |
| Entity Type | Individual |
| Full Name | KYLE J. SMISEK |
| Credential | PA |
| Practice Address |
1645 Lyndale Ave N Ste 103 Faribault MN 55021-2935 |
| Mailing Address |
704 Nevada St Northfield MN 55057-2600 |
| Practice Telephone | 5073341601 |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
12563 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1645 LYNDALE AVE N STE 103 |
| City | FARIBAULT |
| State | MN |
| Zip Code | 55021-2935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023083045 | Bradley Robert Wille | Orthopaedic Surgery | 1645 Lyndale Ave N Ste 103, Faribault, MN 55021-2935 | 2006-02-22 |
| 1043499577 | Hans Carl Bengtson | Orthopaedic Surgery | 1645 Lyndale Ave N Ste 103, Faribault, MN 55021-2935 | 2007-11-01 |
| 1649233081 | Debra Mary Mcguire Lang | Physician Assistant | 1645 Lyndale Ave N Ste 103, Faribault, MN 55021-2935 | 2006-04-07 |
| 1912972936 | Clinton Arthur Muench | Orthopaedic Surgery | 1645 Lyndale Ave N Ste 103, Faribault, MN 55021-2935 | 2006-02-22 |
| 1902871866 | Robert Warren Shepley | Orthopaedic Surgery | 1645 Lyndale Ave N Ste 103, Faribault, MN 55021-2935 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872831 | Kent William Lundstrom | Pharmacist | 612 4th Street Nw, Faribault, MN 55021 | 2020-08-19 |
| 1053957357 | M&t Sisters of Serendipity Pllc | Counselor | 212a Centralave, Faribault, MN 55021 | 2019-11-21 |
| 1639720485 | Reliable Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 200 8th Avenue Nw, Faribault, MN 55021 | 2019-09-24 |
| 1235663428 | Tanya Borchert | Social Worker | 100 State Avenue, Faribault, MN 55021 | 2017-04-14 |
| 1235589854 | Bashir Omar I | Interpreter | 2426 Park Ave # 309, Faribault, MN 55021 | 2016-06-14 |
| 1790150381 | Rainbow United Care Transportation LLC | Non-emergency Medical Transport (VAN) | 1738 Patrick Bay, Faribault, MN 55021 | 2015-12-08 |
| 1740625938 | Steven James Klapmeier | Family Medicine | 1101 Linden Lane, Mcfffrb Health Service, Faribault, MN 55021 | 2013-05-02 |
| 1528306040 | Discovery Public School of Faribault | Local Education Agency (LEA) | 126 8th St. Nw, Faribault, MN 55021 | 2013-01-17 |
| 1164790374 | Emmanuel Douah | Pharmacist | 612 4th Avenue Nw, Faribault, MN 55021 | 2011-12-02 |
| 1770873937 | Faribault Senior Living LLC | Assisted Living Facility | 843 Faribault Road, Faribault, MN 55021 | 2011-04-08 |
| Find all providers in zip 55021 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194120204 | Nathan C Clapper | Physician Assistant | 3580 Arcade St Ste 100, Vadnais Heights, MN 55127-7135 | 2014-10-31 |
| 1003180555 | Elizabeth K Saterenzoller | Physician Assistant | 1015 Marsh Street, Mankato, MN 56002-8673 | 2012-03-01 |
| 1477824472 | Andrea Jo Pitzl | Physician Assistant | 3208 36th Ave Ne, St Anthony, MN 55418-1713 | 2012-01-23 |
| 1447560693 | Jeanine Marie Edstrom | Physician Assistant | 1185 Town Centre Dr Ste 200, Eagan, MN 55123-1343 | 2010-10-20 |
| 1841504792 | Michelle R Aumock | Physician Assistant | 8100 W 78th Street, Ste 230, Edina, MN 55439 | 2010-08-03 |
| 1194042390 | Gerald Frederick Anderson | Physician Assistant | 4060 Haines Rd, #104, Duluth, MN 55811-1746 | 2010-04-27 |
| 1558683904 | Oswaldo Serge | Physician Assistant | 4036 3rd St Nw, Rochester, MN 55901-7564 | 2010-02-25 |
| 1417288945 | Amanda Kay Johnson | Physician Assistant | 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 | 2010-01-22 |
| 1790922755 | Jenelle Cecilia Rock | Physician Assistant | 1950 Northwestern Ave S, Suite 102, Stillwater, MN 55082-7590 | 2009-01-13 |
| 1174775514 | Nathan J Nistler | Physician Assistant | 3580 Arcade Stq, Vadnais Heights, MN 55127-7135 | 2008-10-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.