Healthcare Provider Details

I. General information

NPI: 1538129762
Provider Name (Legal Business Name): BEVERLY M KENNEDY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PROSPECT ST
NASHUA NH
03060-3925
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3053
  • Fax: 603-577-5354
Mailing address:
  • Phone: 603-577-2799
  • Fax: 603-577-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number039588-23-04
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number039588-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: