Healthcare Provider Details

I. General information

NPI: 1003248204
Provider Name (Legal Business Name): KELLY LYNN KENNEDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W CENTRAL ST
NATICK MA
01760-4310
US

IV. Provider business mailing address

199 WINTHROP RD APT 33
BROOKLINE MA
02445-4485
US

V. Phone/Fax

Practice location:
  • Phone: 508-655-2109
  • Fax:
Mailing address:
  • Phone: 518-929-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269814
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: