Provider Demographics
NPI:1033898101
Name:BARTELS, KYLE EUGENE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EUGENE
Last Name:BARTELS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:BONDSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01009-0871
Mailing Address - Country:US
Mailing Address - Phone:860-287-3090
Mailing Address - Fax:
Practice Address - Street 1:3120 MAIN ST
Practice Address - Street 2:
Practice Address - City:BONDSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01009-7751
Practice Address - Country:US
Practice Address - Phone:860-287-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2346332363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty