Healthcare Provider Details

I. General information

NPI: 1386589604
Provider Name (Legal Business Name): KYLE WILLIAM BRUYERE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N 6TH AVE APT 102
HASTINGS NE
68901-5571
US

IV. Provider business mailing address

630 N 6TH AVE APT 102
HASTINGS NE
68901-5571
US

V. Phone/Fax

Practice location:
  • Phone: 402-469-5795
  • Fax:
Mailing address:
  • Phone: 402-469-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: