Healthcare Provider Details

I. General information

NPI: 1225852189
Provider Name (Legal Business Name): KIMBERLY CALLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 IYANNOUGH RD
HYANNIS MA
02601-1839
US

IV. Provider business mailing address

1019 IYANNOUGH RD
HYANNIS MA
02601-1839
US

V. Phone/Fax

Practice location:
  • Phone: 508-771-8010
  • Fax:
Mailing address:
  • Phone: 774-994-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2378660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: