Individual provider · Type 1 NPI

Kyle Rotherham, PA-C

Surgical Physician Assistant · Omaha, NE

NPI number 1780397018 Active

Practice location

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426

Fax (402) 390-4115

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X2867 (NE)
Physician Assistant 363A00000X1204103 (NE)
Physician Assistant 363A00000X2867 (NE)
Physician Assistant 363A00000X118173 (IA)

Surgical Physician Assistant: Definition to come...

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About NPI 1780397018

Kyle Rotherham, PA-C's National Provider Identifier is 1780397018, issued on Jan 2, 2023. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Omaha, NE. The record was last updated on Oct 30, 2025.