Healthcare Provider Details

I. General information

NPI: 1386004091
Provider Name (Legal Business Name): KYLE WARDLE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S COUNTY COMMONS WAY
WAKEFIELD RI
02879-2394
US

IV. Provider business mailing address

50 S COUNTY COMMONS WAY
WAKEFIELD RI
02879-2394
US

V. Phone/Fax

Practice location:
  • Phone: 401-399-4159
  • Fax: 401-587-5341
Mailing address:
  • Phone: 401-399-4159
  • Fax: 401-587-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN00836
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN47897
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN47897
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: