Healthcare Provider Details

I. General information

NPI: 1811810138
Provider Name (Legal Business Name): KYLE BREADY KRUEGER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WASHINGTON ST
GLOUCESTER MA
01930-4836
US

IV. Provider business mailing address

302 WASHINGTON ST
GLOUCESTER MA
01930-4836
US

V. Phone/Fax

Practice location:
  • Phone: 978-282-8899
  • Fax: 978-759-7028
Mailing address:
  • Phone: 978-282-8899
  • Fax: 978-759-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2347531
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: