Provider Demographics
NPI:1891902730
Name:BERNARD, KATHLEEN M (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:BERNARD
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 421
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-973-5293
Practice Address - Fax:207-973-5263
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2016-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MECNP91030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME274250099Medicaid
ME274250099Medicaid