Healthcare Provider Details

I. General information

NPI: 1700153285
Provider Name (Legal Business Name): KERRI ANN QUINN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRI ANN PEPKA

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 FRANKLIN ST STE 1702
BOSTON MA
02110-3144
US

IV. Provider business mailing address

18 SCOTT RD APT 2L
CUMBERLAND RI
02864-2853
US

V. Phone/Fax

Practice location:
  • Phone: 415-840-0560
  • Fax:
Mailing address:
  • Phone: 207-522-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181310
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2261504
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN48135
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01414
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: