Healthcare Provider Details

I. General information

NPI: 1225036486
Provider Name (Legal Business Name): KRISTIN A MCCARTHY F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MAIN ST
ATHOL MA
01331-2102
US

IV. Provider business mailing address

201 S MAIN ST
ATHOL MA
01331-2102
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-0099
  • Fax: 978-249-7227
Mailing address:
  • Phone: 978-249-0099
  • Fax: 978-249-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number195585
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: