Healthcare Provider Details

I. General information

NPI: 1124776083
Provider Name (Legal Business Name): KAELYN MELANSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 HAVEN ST
READING MA
01867-2929
US

IV. Provider business mailing address

52 HAVEN ST
READING MA
01867-2929
US

V. Phone/Fax

Practice location:
  • Phone: 781-944-2050
  • Fax:
Mailing address:
  • Phone: 781-484-6880
  • Fax: 781-942-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2351003
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2351003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: