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Kyle I. Pirtle

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

200 NE Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299

PECOS Enrollment

This provider is enrolled in PECOS as KYLE PIRTLE.

Based on the most recent information from CMS, provider Kyle I. Pirtle is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1275578742
Provider Type
Individual
Full Name
Pirtle, Kyle I.
Credential
P.A.-C.

Gender
Male
Sole Proprietor
No
Enumeration Date
6/18/2006
Last Updated
10/10/2007

Contact Information

Practice Location

200 NE Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299

(360) 254-6161

(360) 449-1146

Mailing Location

200 NE Mother Joseph Pl, Suite 210, Vancouver, WA 98664-3299

(360) 254-6161

(360) 449-1139

Provider Taxonomies

Code	Description	License
Code 363AS0400X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA10002029 Washington

Provider Identifiers

ID	Description	Issuer
ID 8355182	Description Medicaid	Issuer Unlisted Washington

Kyle I. Pirtle

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Etherton, Michaela

Boundy, Brian Forrest

Chan, Vivian

Hermes, Jennifer D

Babcock, Rebecca L

Carson, Christopher E.

Ramme, Laura Deesha

Rosenfeld, Bonnie L.

Nguyen, Angel

Black, Timothy