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General NPI Number Information
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NPI Number | 1790810257
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Entity Type | Individual
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Provider Name | MARY ANN HETTICH-KELLY APRN CNS PSYCH
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 259 NORTH ST # A
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City | HYANNIS
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State | MA
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Zip | 02601-3834
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Country | US
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Telephone | 508-862-0514
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Fax | 508-862-0514
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Provider Business Mailing Address
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Address Line | 259 NORTH ST # A
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City | HYANNIS
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State | MA
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Zip | 02601-3834
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Country | US
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Telephone | 508-862-0514
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Fax | 508-862-9184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 197116
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 364SP0812X
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Taxonomy Name | Community Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 197116
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License Number State | MA
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