KYLE J HENNEBERRY MD (Credential# 562594) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is February 1, 2020. The license expiration date date is January 31, 2021. The license status is ACTIVE.
KYLE J HENNEBERRY MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.045012. The credential type is physician/surgeon. The effective date is February 1, 2020. The expiration date is January 31, 2021. The business address is 16624 Ne 162nd Court, Woodinville, WA 98072. The current status is active.
| Licensee Name | KYLE J HENNEBERRY MD |
| Credential ID | 562594 |
| Credential Number | 1.045012 |
| Credential Type | Physician/Surgeon |
| Business Address |
16624 Ne 162nd Court Woodinville WA 98072 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2007-01-03 |
| Effective Date | 2020-02-01 |
| Expiration Date | 2021-01-31 |
| Refresh Date | 2020-01-13 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 461399 | CSP.0041057 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2007-02-01 | 2011-03-01 - 2013-02-28 | INACTIVE |
| Street Address | 16624 NE 162nd Court |
| City | Woodinville |
| State | WA |
| Zip Code | 98072 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ste Michelle Wine Estates Ltd · Erath Vineyards | 14111 Ne 145th Street, Woodinville, WA 98072 | Out of State Winery | 2020-03-22 ~ 2021-03-21 |
| Robert David Olson | 17623 168th Pl Ne, Woodinville, WA 98072 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Carlene L Gaudette | 15817 Ne 178th Pl, Woodinville, WA 98072 | Registered Nurse | 2019-11-01 ~ 2020-10-31 |
| Bda Inc | 15525 Woodinville-redmond Rd Ne, Woodinville, WA 98072 | Manufacturer of Bedding & Upholstered Furniture | 2017-05-31 ~ 2018-04-30 |
| Denise M Caracoglia | 23516 51st Ave S E, Woodinville, WA 98072 | Pharmacy Technician | 2009-04-01 ~ 2010-03-31 |
| Oldfield Cellars LLC · Efeste | 19730 144the Ave Ne, Woodinville, WA 98072 | Out of State Winery | ~ |
| James C Desalvo | 14750 149th Ave Ne, Woodinville, WA 98072 | Professional Engineer | 1998-02-01 ~ 1999-01-31 |
| Joseph R Santosuosso · Lockheed Shipbuilding Co | 13615-209th Avenue N.e., Woodinville, WA 98072 | Professional Engineer | 1989-04-04 ~ 1990-01-31 |
| Conrad W Felice | 14150 227th Ave N E, Woodinville, WA 98072 | Professional Engineer | 2009-02-01 ~ 2010-01-31 |
| Laurie Jo Anderson | 12524 Ne 168th Ct., Woodinville, WA 98072 | Certified Public Accountant License | 2006-01-01 ~ 2006-12-31 |
| Find all Licenses in zip 98072 | |||
| City | Woodinville |
| Zip Code | 98072 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Woodinville |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kyle M Gibson | 265 1st Ave Apt 1, New York, NY 10003-2996 | Physician/surgeon | 2015-06-01 ~ 2016-05-31 |
| Kyle T Bramley | 15 York St, New Haven, CT 06510 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Kyle Shepard | 80 Seymour St, Hartford, CT 06106-3315 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Kyle B Mcclaine | 326 Washington St, Norwich, CT 06360-5634 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Kyle T Elligers | 374 Grand Ave, New Haven, CT 06513-3733 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Donald B Alderman | 733 Kyle Lane, New Haven, CT 06515 | Physician/surgeon | 1993-03-24 ~ 1994-02-28 |
| Anthony Cubb | 2512 Kyle Ct, Columbia, MO 65203-5709 | Physician/surgeon | 1989-07-14 ~ 1990-04-30 |
| Kyle P Nielson | 1300 Boblett St # 374, Blaine, WA 98230-9716 | Physician/surgeon | 2016-02-01 ~ 2017-01-31 |
| Kyle Cecil Mciver | 78 Russel Ave, Suffield, CT 06078 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Kyle R Vanstone | 8025 Bonhomme Ave Apt 2002, Clayton, MO 63105 | Physician/surgeon | 2014-11-01 ~ 2015-10-31 |
Please comment or provide details below to improve the information on KYLE J HENNEBERRY MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).