Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 3014236 | KY |
NPI | 1003446667 |
---|---|
Provider Name | Kyle Andrew Bloomfield |
First Address | Lexington, KY 40503-1431 |
Second Address | Lexington, KY 40503-1457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3014236 | KY APRN LICENSE (01) | KY |