Provider Demographics
NPI:1093049165
Name:RAMOS, KELLY LYNNE (MSN, CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MSN, CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNNE
Other - Last Name:THERIAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5112 ARCHSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1870
Mailing Address - Country:US
Mailing Address - Phone:978-551-1900
Mailing Address - Fax:
Practice Address - Street 1:5112 ARCHSTONE AVE
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1870
Practice Address - Country:US
Practice Address - Phone:978-551-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261903363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology