Provider Demographics
NPI:1275305567
Name:LINDBERG, KYLIE BROWN (FNP)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:BROWN
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 WHITEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0431
Mailing Address - Country:US
Mailing Address - Phone:443-820-6964
Mailing Address - Fax:
Practice Address - Street 1:7940 WILLIAMS POND LN STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8410
Practice Address - Country:US
Practice Address - Phone:704-752-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC288336163W00000X
NC5020592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse