Healthcare Provider Details

I. General information

NPI: 1760146476
Provider Name (Legal Business Name): KYLEY JENNIFER CALDWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SPRING ST STE 101
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

49 SPRING ST STE 101
SCARBOROUGH ME
04074-8926
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-7926
  • Fax: 207-618-5021
Mailing address:
  • Phone: 207-883-7926
  • Fax: 207-618-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015281
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261518
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: