Basic Information
| Provider Information | |||||||||
| NPI: | 1962005835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERES | ||||||||
| FirstName: | KYLE MARIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 MANAMOK CIR | ||||||||
| Address2: | |||||||||
| City: | SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025632679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477677008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 ANSEL HALLET RD | ||||||||
| Address2: | |||||||||
| City: | WEST YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026732582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087718350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2020 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2308010 | MA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN2308010 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.