Individual ProviderChristopher Douglas KyleNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 664-7048(516) 945-3000PECOS EnrollmentBased on the most recent information from CMS, provider Christopher Douglas Kyle does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1598061053Provider TypeIndividualFull NameKyle, Christopher DouglasTitleMr.CredentialCRNAGenderMaleSole ProprietorNoEnumeration Date2/1/2011Last Updated3/23/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 664-7048Fax(703) 644-7402Mailing LocationMailing Address68 S Service Rd, Melville, NY 11747-2358Phone(516) 945-3000Fax(516) 945-3131Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024169251VirginiaCode367500000XDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR191518MarylandCode367500000XDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseNA4420CaliforniaProvider IdentifiersIDDescriptionIssuerID1598061053DescriptionMedicaidIssuerUnlistedVirginiaID011150500DescriptionMedicaidIssuerUnlistedFloridaID4225490DescriptionMedicaidIssuerUnlistedMaryland