Provider Demographics
NPI:1194179846
Name:SOARES, KELSEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAWES DR
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1608
Mailing Address - Country:US
Mailing Address - Phone:508-567-7649
Mailing Address - Fax:
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1601
Practice Address - Country:US
Practice Address - Phone:781-624-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2301784OtherRN LICENSE