Individual
KYLIE BROUGHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7 CENTRAL ST, PROVIDENCE, RI 02907-2201
(401) 648-4700
Mailing address
7 CENTRAL ST, PROVIDENCE, RI 02907-2201
(401) 648-4700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
022166
NY
363AM0700X
Medical Physician Assistant
Primary
PA01436
RI
Other
Enumeration date
07/24/2018
Last updated
03/28/2025
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