Healthcare Provider Details

I. General information

NPI: 1184399677
Provider Name (Legal Business Name): KYLEIGH ALEXIS GOLEMBESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 OLD NORTH RD
WORTHINGTON MA
01098-9753
US

IV. Provider business mailing address

58 OLD NORTH RD
WORTHINGTON MA
01098-9753
US

V. Phone/Fax

Practice location:
  • Phone: 413-238-5511
  • Fax:
Mailing address:
  • Phone: 413-238-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2350083
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: