Provider Demographics
NPI:1215608542
Name:ALBANO, KYLE CHARLES (NP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:CHARLES
Last Name:ALBANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:CHARLES
Other - Last Name:ALBANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-973-5918
Practice Address - Fax:508-973-5916
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311273363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine