MEDICARE: MR. PETER JOHN KENNEDY MSN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN2308844	MA
2	363LG0600X	Gerontology Nurse Practitioner	RN2308844	MA

General Provider Information

NPI Number	:	1558973396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER JOHN KENNEDY MSN, NP-C

Provider Business Mailing Address
First Line	:	330 BROOKLINE AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MALL RD
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01805-5491
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2020
Last Update Date	:	01/16/2024

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Directions to “ MR. PETER JOHN KENNEDY MSN, NP-C” Practice Location

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