Healthcare Provider Details

I. General information

NPI: 1063494995
Provider Name (Legal Business Name): KIMBERLY J ADAMSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BOYDEN RD
HOLDEN MA
01520-2570
US

IV. Provider business mailing address

64 BOYDEN RD
HOLDEN MA
01520-2570
US

V. Phone/Fax

Practice location:
  • Phone: 508-885-2003
  • Fax: 508-885-8071
Mailing address:
  • Phone: 508-885-2003
  • Fax: 508-885-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number235904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: