Healthcare Provider Details

I. General information

NPI: 1750181459
Provider Name (Legal Business Name): KEVIN RICHARD OWENS JR. PMHNP-BC, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 32A
CANTON MA
02021-2853
US

IV. Provider business mailing address

42 BOYDEN RD
HOLDEN MA
01520-2514
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7343
  • Fax:
Mailing address:
  • Phone: 774-641-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2325346
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2325346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: