Healthcare Provider Details

I. General information

NPI: 1902976384
Provider Name (Legal Business Name): KATHLEEN ANNE O CALLAHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHEAST PAIN MANAGEMENT 1365 BROADWAY
BANGER ME
04401
US

IV. Provider business mailing address

140 CHANDLER ST
PITTSFIELD ME
04967-3711
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-6226
  • Fax: 207-992-2753
Mailing address:
  • Phone: 207-487-9244
  • Fax: 207-368-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP149141
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP141113
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: