Healthcare Provider Details

I. General information

NPI: 1659112290
Provider Name (Legal Business Name): KYLE JUDITH ARSENAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 BRIER CREEK PKWY STE 105-501
RALEIGH NC
27617-7328
US

IV. Provider business mailing address

10 BEAU MONDE DR
NORTH HAMPTON NH
03862-2018
US

V. Phone/Fax

Practice location:
  • Phone: 336-560-7878
  • Fax:
Mailing address:
  • Phone: 603-918-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: