Provider Demographics
NPI:1114089703
Name:FYRBERG, KACIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:LYNN
Last Name:FYRBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BYFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01922-2734
Mailing Address - Country:US
Mailing Address - Phone:978-499-3125
Mailing Address - Fax:978-499-3239
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:BYFIELD
Practice Address - State:MA
Practice Address - Zip Code:01922-2734
Practice Address - Country:US
Practice Address - Phone:978-499-3125
Practice Address - Fax:978-499-3239
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner