Healthcare Provider Details

I. General information

NPI: 1619650751
Provider Name (Legal Business Name): KELSEY ROUSSEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST STE 305
LOWELL MA
01852-1318
US

IV. Provider business mailing address

33 BARTLETT ST STE 305
LOWELL MA
01852-1318
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-2200
  • Fax:
Mailing address:
  • Phone: 978-452-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2316834
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: