Healthcare Provider Details

I. General information

NPI: 1467368886
Provider Name (Legal Business Name): KELSEY LUTAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 FRANK B MURRAY ST
SPRINGFIELD MA
01103-1106
US

IV. Provider business mailing address

195 HOPKINS LN
BECKET MA
01223-9462
US

V. Phone/Fax

Practice location:
  • Phone: 413-349-5033
  • Fax:
Mailing address:
  • Phone: 413-349-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: