Havercroft, Kyle Jacob

Havercroft, Kyle Jacob is an individual health care provider with primary practice located at 1107 W Ironwood Dr , Coeur D Alene ID 83814-2604. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Havercroft, Kyle Jacob can be contacted via phone (208) 667-7459.

Contact Information

Primary practice address
1107 W Ironwood Dr Coeur D Alene ID 83814-2604
Phone: (208) 667-7459
Fax: (208) 667-2631
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA-1313 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-1313 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-1313 Idaho

Profile Details

NPI number 1700063344
LBN Legal business name Havercroft, Kyle Jacob
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2008
Last updated Oct 20th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700063344 NPPES
Other 1083729438 LINKED TO OSSM ORGANIZATION

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