Healthcare Provider Details

I. General information

NPI: 1124965710
Provider Name (Legal Business Name): KYLEE KERNS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VANDENBERG DR
HANSCOM AFB MA
01731-2104
US

IV. Provider business mailing address

8131 AVALON DR
WILMINGTON MA
01887-1169
US

V. Phone/Fax

Practice location:
  • Phone: 781-225-6789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2273658
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2273658
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: