Provider Demographics
NPI:1144376906
Name:O'MEARA, KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MICA LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1724
Mailing Address - Country:US
Mailing Address - Phone:781-431-0207
Mailing Address - Fax:
Practice Address - Street 1:27 MICA LN
Practice Address - Street 2:SUITE 205
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1724
Practice Address - Country:US
Practice Address - Phone:781-431-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105911364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health