Provider Demographics
NPI:1306490677
Name:BERNIER, KYLE LEONARD (MAATC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:LEONARD
Last Name:BERNIER
Suffix:
Gender:M
Credentials:MAATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 LEXINGTON AVE N APT B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2018
Mailing Address - Country:US
Mailing Address - Phone:701-540-7382
Mailing Address - Fax:
Practice Address - Street 1:1295 BANDANA BLVD W
Practice Address - Street 2:SUITE 210
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program