Provider Demographics
NPI:1457111700
Name:MCLEAN, KYLE (NRP, CPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:NRP, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES RD STE 1000A
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7812
Mailing Address - Country:US
Mailing Address - Phone:203-695-7210
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000A
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:203-695-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT106027146L00000X
E6K2Z3J8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic