MR. KYLE PAUL BLOMGREN DO
NPI 1578021895
Student in an Organized Health Care Education/Training Program in Fayetteville, NC

Q: What is Kyle Blomgren's NPI number?

The NPI number for Kyle Blomgren is 1578021895. It was assigned to this individual provider in the NPPES registry on March 5, 2019.

Q: What is Kyle Blomgren's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kyle Blomgren was last updated on April 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 05, 2019PECOS Enrolled

1638 OWEN DR, FAYETTEVILLE, NC 28304(910) 615-4000 Get Directions Write a Review

NPPES record last updated: April 21, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 21, 2021, Mar 5, 2019 (2 updates tracked since 2019).

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About Mr. Kyle Paul Blomgren Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KYLE PAUL BLOMGREN DO (NPI 1578021895) is an individual student in an organized health care education/training program in Fayetteville, North Carolina and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1578021895

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMR. KYLE PAUL BLOMGRENCredential: DO

Location Address1638 OWEN DRFayetteville, NC 28304-3424

Mailing Address1638 Owen DrFayetteville, NC 28304-3424 · (910) 615-4000

Phone(910) 615-4000

Sole ProprietorNo

Enumeration DateMarch 5, 2019

Last NPPES UpdateApril 21, 20212 updates tracked since enumeration

NPPES CertifiedApril 21, 2021

✔ NPI 1578021895 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1638 OWEN DR, Fayetteville, NC 28304

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kyle Paul Blomgren Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATHER MCPHAIL COAXUM NP

Nurse Practitioner (Family)