Provider Demographics
NPI:1043234727
Name:KEADY, JOYCE (PNP, RN)
Entity Type:Individual
Prefix:MR
First Name:JOYCE
Middle Name:
Last Name:KEADY
Suffix:
Gender:F
Credentials:PNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3237
Mailing Address - Country:US
Mailing Address - Phone:617-309-4499
Mailing Address - Fax:617-309-2451
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-309-4499
Practice Address - Fax:617-309-2451
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229761363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics