Healthcare Provider Details

I. General information

NPI: 1891804472
Provider Name (Legal Business Name): PATRICIA A KENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

157 KENWOOD DR
RUTLAND MA
01543-1542
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9771
  • Fax: 508-764-2499
Mailing address:
  • Phone: 508-886-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number207969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: