Provider Demographics
NPI:1225097173
Name:SMALL, KATHRYN R (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:R
Last Name:SMALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ORNAC
Mailing Address - Street 2:EMERSON HOSPITAL CREDENTIALS
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-3018
Mailing Address - Fax:978-287-3122
Practice Address - Street 1:133 ORNAC
Practice Address - Street 2:EMERSON HOSPITAL CREDENTIALS
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-3167
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232541363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4949OtherBLUE CROSS BS MA
MA81023OtherFALLON
MANP4949OtherBLUE CROSS BS MA
MA81023OtherFALLON