1679636286 NPI number — MS. KATHLEEN MARY KELLY BROWN NP

Table of content: MS. KATHLEEN MARY KELLY BROWN NP (NPI 1679636286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679636286 NPI number — MS. KATHLEEN MARY KELLY BROWN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
KATHLEEN
Provider Middle Name:
MARY KELLY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679636286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CAMBRIDGE ST FL 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-731-8994
Provider Business Mailing Address Fax Number:
508-473-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CAMBRIDGE ST FL 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-731-8994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  252702 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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