Healthcare Provider Details

I. General information

NPI: 1730012832
Provider Name (Legal Business Name): KELLY MCGUINNESS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

IV. Provider business mailing address

21 BAYBERRY RD
GROTON MA
01450-2068
US

V. Phone/Fax

Practice location:
  • Phone: 413-594-3111
  • Fax:
Mailing address:
  • Phone: 978-512-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: