Healthcare Provider Details

I. General information

NPI: 1427506872
Provider Name (Legal Business Name): KAITLIN MARIE PICARD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CONSTITUTION PLZ STE 140
CHARLESTOWN MA
02129-2025
US

IV. Provider business mailing address

1 CONSTITUTION PLZ STE 140
CHARLESTOWN MA
02129-2025
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-5202
  • Fax: 617-726-7709
Mailing address:
  • Phone: 617-724-5202
  • Fax: 617-726-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2307299
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2307299
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: