Healthcare Provider Details

I. General information

NPI: 1114601754
Provider Name (Legal Business Name): MEAGHAN KILLEEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 RUSSELL ST
HADLEY MA
01035-3534
US

IV. Provider business mailing address

234 RUSSELL ST
HADLEY MA
01035-3534
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2330673
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: