Healthcare Provider Details

I. General information

NPI: 1962543793
Provider Name (Legal Business Name): PATRICIA M KELLOGG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PRIMROSE ST STE 202
HAVERHILL MA
01830-2659
US

IV. Provider business mailing address

24 MORRILL PL STE 2
AMESBURY MA
01913-3530
US

V. Phone/Fax

Practice location:
  • Phone: 978-556-1000
  • Fax: 978-556-0101
Mailing address:
  • Phone: 978-834-8074
  • Fax: 978-834-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number163778
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: