Provider Demographics
NPI:1467972422
Name:O'ROURKE, KYLE (NP)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOUNT EBO RD S STE 1
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4092
Mailing Address - Country:US
Mailing Address - Phone:845-278-6930
Mailing Address - Fax:845-278-6932
Practice Address - Street 1:15 MOUNT EBO RD S STE 1
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4092
Practice Address - Country:US
Practice Address - Phone:845-278-6930
Practice Address - Fax:845-278-6932
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350041363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily