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

Mr. Kyle J Havercroft, PA-C

Individual provider Surgical Physician Assistant · NPI 1700063344

Mr. Kyle J Havercroft, PA-C is a Physician Assistant in Coeur D Alene, Idaho. Qualified in 2015, 11 years ago. Practices with Orthopedic Surgery and Sports, a 28-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
11
Licensed in
ID
In the registry since
2008
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

850 W Ironwood Dr Ste 202
Coeur D Alene, ID 83814-4903
Phone: (208) 664-2175
Fax: (208) 664-1226
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA-1313 (ID)
Physician Assistant Taxonomy 363A00000X · Licence PA-1313 (ID)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA-1313 (ID)

Record details

NPI number1700063344
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 25, 2008
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Orthopedic Surgery And Sports — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Coeur D Alene