Healthcare Provider Details

I. General information

NPI: 1790607877
Provider Name (Legal Business Name): BRIANNA ELEANOR KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

24 ELIOT ST
BILLERICA MA
01821-4220
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2000
  • Fax:
Mailing address:
  • Phone: 857-998-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10008472
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-196682
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: