Healthcare Provider Details

I. General information

NPI: 1790592301
Provider Name (Legal Business Name): KELLY GARRITY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BEDFORD ST
WHITMAN MA
02382-1859
US

IV. Provider business mailing address

21 BRAMBLEWOOD ST
BRIDGEWATER MA
02324-2875
US

V. Phone/Fax

Practice location:
  • Phone: 781-792-6000
  • Fax:
Mailing address:
  • Phone: 508-577-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2327550
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: