Healthcare Provider Details

I. General information

NPI: 1730799875
Provider Name (Legal Business Name): KYLE ANDERS HOLMQUIST NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYLE AARON BRENTON

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DEPOT ST
KENNEBUNK ME
04043-7038
US

IV. Provider business mailing address

75 FOREST ST
SACO ME
04072-3110
US

V. Phone/Fax

Practice location:
  • Phone: 207-569-2021
  • Fax: 207-203-4641
Mailing address:
  • Phone: 207-929-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number086005-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201064
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN73053
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: