KYLE ROTHERHAM PA-C NPI 1780397018

NPI Information

  • NPI: 1780397018
  • Provider Name: KYLE ROTHERHAM, PA-C
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 8005 FARNAM DR STE 305
    OMAHA, NE
    ZIP 68114
  • Phone: (402) 390-4111

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NPI Details

Kyle Rotherham, PA-C is a surgical physician assistant in Omaha, NE with 4 years of experience. Kyle Rotherham, PA-C NPI is 1780397018. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2022

The provider's business location address is:

8005 FARNAM DR STE 305
OMAHA, NE
ZIP 68114-426
Phone: (402) 390-4111
Fax: (402) 390-4115

The NPI 1780397018 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/2/2023 and was last updated on 10/30/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AS0400XPhysician AssistantSurgical2867NEBRASKAYes
2363A00000XPhysician Assistant1204103NEBRASKANo
3363A00000XPhysician Assistant2867NEBRASKANo
4363A00000XPhysician Assistant118173IOWANo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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