Provider Demographics
NPI:1740228675
Name:BUSS, KYLE W (PA-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:W
Last Name:BUSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6209
Mailing Address - Country:US
Mailing Address - Phone:720-549-8450
Mailing Address - Fax:303-953-1757
Practice Address - Street 1:7500 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6209
Practice Address - Country:US
Practice Address - Phone:720-549-8450
Practice Address - Fax:303-953-1757
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1585363AM0700X
WAPA60795056363AM0700X
COPA.0001585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740228675Medicaid
WAG8976750OtherPECOS
CO21729867Medicaid
COCO301525Medicare PIN