Healthcare Provider Details

I. General information

NPI: 1538991468
Provider Name (Legal Business Name): MARY LILY KIMATU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST STE 1
HOLYOKE MA
01040-5140
US

IV. Provider business mailing address

70 MAIN ST
FLORENCE MA
01062-1466
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax:
Mailing address:
  • Phone: 413-586-8400
  • Fax: 866-644-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2303335
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: