Healthcare Provider Details

I. General information

NPI: 1386338317
Provider Name (Legal Business Name): KAITLYN FINNERAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

14 BROWNS CT
RYE NH
03870-2615
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: