Provider Demographics
NPI:1679715528
Name:LEPINO, KYLE J (APRN)
Entity type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:J
Last Name:LEPINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KYLE
Other - Middle Name:J
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:19 S. WALNUT ST., STE C
Mailing Address - Street 2:P.O. BOX 530
Mailing Address - City:WAUREGAN
Mailing Address - State:CT
Mailing Address - Zip Code:06387
Mailing Address - Country:US
Mailing Address - Phone:860-207-8160
Mailing Address - Fax:860-207-8170
Practice Address - Street 1:19 S. WALNUT ST., STE C
Practice Address - Street 2:
Practice Address - City:WAUREGAN
Practice Address - State:CT
Practice Address - Zip Code:06387
Practice Address - Country:US
Practice Address - Phone:860-207-8160
Practice Address - Fax:860-207-8170
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002043164W00000X, 364SF0001X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health