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General NPI Number Information
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NPI Number | 1730799875
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Entity Type | Individual
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Provider Name | KYLE ANDERS HOLMQUIST NP-C
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Gender | Male
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 12 DEPOT ST
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City | KENNEBUNK
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State | ME
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Zip | 04043-7038
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Country | US
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Telephone | 207-569-2021
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Fax | 207-203-4641
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Provider Business Mailing Address
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Address Line | 75 FOREST ST
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City | SACO
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State | ME
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Zip | 04072-3110
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Country | US
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Telephone | 207-929-0170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 086005-23
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP201064
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN73053
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License Number State | ME
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