Provider Demographics
NPI:1275926479
Name:GEROULD, KYLE (LPN)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:GEROULD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6758 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9317
Mailing Address - Country:US
Mailing Address - Phone:585-991-9899
Mailing Address - Fax:
Practice Address - Street 1:6758 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:NY
Practice Address - Zip Code:14487-9317
Practice Address - Country:US
Practice Address - Phone:585-991-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316218-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse