Provider Demographics
NPI:1235772724
Name:SOUCY, KATHRYN M (CNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:SOUCY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:FICHERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 CHRISTIAN CIR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-8800
Mailing Address - Country:US
Mailing Address - Phone:978-852-0968
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-557-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2278879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily