MEDICARE: MS. KERRY LEE O'CONNOR N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	192280	MA

General Provider Information

NPI Number	:	1548451156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRY LEE O'CONNOR N.P.

Provider Business Mailing Address
First Line	:	120 THOMAS ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1223
Country	:	US
Telephone Number	:	508-756-7176
Fax Number	:	508-792-4927

Provider Business Practice Location Address
First Line	:	120 THOMAS ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1223
Country	:	US
Telephone Number	:	508-756-7176
Fax Number	:	508-792-4927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	12/15/2015

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