Healthcare Provider Details

I. General information

NPI: 1992387526
Provider Name (Legal Business Name): JESSICA ELAINE KEHOE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 01/04/2022
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

801 ALBANY ST FL G
BOSTON MA
02119-3791
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5245
  • Fax: 617-414-5520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2277672
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: