Healthcare Provider Details

I. General information

NPI: 1720930845
Provider Name (Legal Business Name): JENNIFER HEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4169
US

IV. Provider business mailing address

54 BAKER AVENUE EXT
CONCORD MA
01742-2137
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3165
  • Fax:
Mailing address:
  • Phone: 978-369-5391
  • Fax: 978-369-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA102404
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: