Healthcare Provider Details

I. General information

NPI: 1164338661
Provider Name (Legal Business Name): KELLY MARIE GAFFNEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W BROADWAY APT 4
BOSTON MA
02127-5001
US

IV. Provider business mailing address

216 W BROADWAY APT 4
BOSTON MA
02127-5001
US

V. Phone/Fax

Practice location:
  • Phone: 203-695-5477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2349487
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: