Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kyle Boltson

Individual provider Family Medicine Physician · NPI 1790363158

Kyle Boltson is a Family Practice in Port Saint Lucie, Florida. Qualified in 2023, 3 years ago. Practices with Conviva Medical Center Management, LLC, a 562-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
3
Licensed in
FL
In the registry since
2021
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Practice location Address checks out

1700 SE Hillmoor Dr Ste 500
Port Saint Lucie, FL 34952-7536
Phone: (772) 873-1770
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence OS20226 (FL)

Record details

NPI number1790363158
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 29, 2021
Last updated in NPPESFebruary 25, 2026
Certification dateFebruary 25, 2026
Mailing address6101 Blue Lagoon Dr Ste 200, Miami, FL 33126-3168

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Conviva Medical Center Management, Llc — 562 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Port Saint Lucie