Healthcare Provider Details

I. General information

NPI: 1679715528
Provider Name (Legal Business Name): KYLE J. LEPINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLE J. FULLER APRN

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S. WALNUT ST., STE C
WAUREGAN CT
06387
US

IV. Provider business mailing address

19 S. WALNUT ST., STE C P.O. BOX 530
WAUREGAN CT
06387
US

V. Phone/Fax

Practice location:
  • Phone: 860-207-8160
  • Fax: 860-207-8170
Mailing address:
  • Phone: 860-207-8160
  • Fax: 860-207-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number002043
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number002043
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number002043
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: