=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558044164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY SANTOS APRN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2023
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 STATE AVE
-----------------------------------------------------
City | TIVERTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02878-1062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-300-3444
-----------------------------------------------------
Fax | 774-307-9039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 EASTVIEW AVE
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02726-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-244-9731
-----------------------------------------------------
Fax | 774-307-9039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN2325826
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------