Healthcare Provider Details

I. General information

NPI: 1083085575
Provider Name (Legal Business Name): AUDRA A NOONAN PMHNP AGPCNP ,ACHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 FRONT ST
MARION MA
02738-1501
US

IV. Provider business mailing address

156 FRONT ST
MARION MA
02738-1501
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-3736
  • Fax:
Mailing address:
  • Phone: 508-748-3736
  • Fax: 508-748-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN264353
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN00762
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number264353
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN00762
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberRN264353
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN00762
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN00762
License Number StateRI
# 8
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN264353
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: