Kyle William Martin Mogensen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

9040A Jackson Ave
Joint Base Lewis McChord, WA 98431-0001

Phone

(253) 968-1110

NPI assigned

Jul 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1306419957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040A JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984310001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040A JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "683 Waianae Ave",
            "address_2": "Schofield Barracks",
            "address_purpose": "LOCATION",
            "city": "Schofield Barracks",
            "state": "HI",
            "postal_code": "96786",
            "country_code": "US",
            "telephone_number": "808-433-8454",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Jarrett White Rd",
            "address_purpose": "LOCATION",
            "city": "Tripler Army Medical Center",
            "state": "HI",
            "postal_code": "968595001",
            "country_code": "US",
            "telephone_number": "808-433-6661",
            "fax_number": "808-433-1551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOGENSEN",
        "first_name": "KYLE",
        "middle_name": "WILLIAM MARTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-21",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Christopher Miller, M.D.
• Chadwick Austin Milligan
• Miranda Cannon PLLC
• Allison Perry Mitchell, CNM
• Jodie Mitchell
• Jayce Moody
• Jessica Marie Moore, LMP
• Michael Benjamin Moore, DO
• Emani Georgette Morgan
• Ronald Richardson Morris, MD

• Physician Assistant in Joint Base Lewis McChord, WA
• Providers in Joint Base Lewis McChord, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.