Provider Demographics
NPI:1245381664
Name:KELLEHER, ALEXIS P (NP-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:P
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:NP-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 CENTRE STREET
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-363-8010
Mailing Address - Fax:617-363-8929
Practice Address - Street 1:1200 CENTRE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-363-8010
Practice Address - Fax:617-363-8929
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2015-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA215635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health