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

Kyle Fetterolf, PA

Individual provider Physician Assistant · NPI 1477529501

Kyle Fetterolf, PA is a Physician Assistant in Kingston, Pennsylvania. Qualified in 1999, 27 years ago. Practices with Commonwealth Physician Network LLC, a 63-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
27
Licensed in
PA
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

423 3rd Ave Ste B
Kingston, PA 18704-5809
Phone: (570) 288-3601
Fax: (570) 288-1726
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 334 Main St, Dickson City, PA 18519-1668 — (888) 952-6772
  • 575 N River St, Wilkes Barre, PA 18764-0999 — (570) 270-9192
  • 677 Kidder St Ste D, Wilkes Barre Township, PA 18702-6914 — (570) 825-2046

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence MA001889L (PA)

Record details

NPI number1477529501
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 28, 2006
Last updated in NPPESFebruary 13, 2025
Certification dateFebruary 13, 2025
Mailing address423 3rd Ave Ste B, Kingston, PA 18704-5809

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Commonwealth Physician Network Llc — 63 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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