Provider Demographics
NPI:1215640552
Name:RYAN, KAILEN BENT (RN)
Entity type:Individual
Prefix:MS
First Name:KAILEN
Middle Name:BENT
Last Name:RYAN
Suffix:
Gender:
Credentials:RN
Other - Prefix:MS
Other - First Name:KAILEN
Other - Middle Name:HILLARY
Other - Last Name:BENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2904
Mailing Address - Country:US
Mailing Address - Phone:413-475-2535
Mailing Address - Fax:
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3229
Practice Address - Country:US
Practice Address - Phone:413-475-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MARN251320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program