Healthcare Provider Details

I. General information

NPI: 1609375971
Provider Name (Legal Business Name): KAILA N CONNOLLY RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

127 M ST
BOSTON MA
02127-3176
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2313891
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2313891
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: