Provider Demographics
NPI:1386004091
Name:WARDLE, KYLE (RN)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WARDLE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3176
Mailing Address - Country:US
Mailing Address - Phone:401-783-8077
Mailing Address - Fax:401-789-6029
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3176
Practice Address - Country:US
Practice Address - Phone:401-783-8077
Practice Address - Fax:401-789-6029
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN47897163W00000X, 163WG0600X
RIAPRN00836363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology