Healthcare Provider Details

I. General information

NPI: 1376215186
Provider Name (Legal Business Name): SHEALAN KAREN GAGNON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST
HYANNIS MA
02601-3145
US

IV. Provider business mailing address

2697 CRANBERRY HWY APT 40
WAREHAM MA
02571-5017
US

V. Phone/Fax

Practice location:
  • Phone: 833-229-2683
  • Fax:
Mailing address:
  • Phone: 508-274-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2356687
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2356687
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: