Healthcare Provider Details

I. General information

NPI: 1861971913
Provider Name (Legal Business Name): KENNETH ANDREW VASQUES CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

874 PURCHASE ST
NEW BEDFORD MA
02740-6232
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-5222
  • Fax:
Mailing address:
  • Phone: 508-992-6553
  • Fax: 508-997-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2313030
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: