Provider Demographics
NPI:1346501012
Name:CRICKS, KELLY ANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CRICKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2467
Mailing Address - Country:US
Mailing Address - Phone:714-600-1379
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST.
Practice Address - Street 2:WACHUSETT EMERGENCY PHYSICIANS
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-786-3483
Practice Address - Fax:978-466-8821
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20810363LA2200X
MARN2297969363LA2200X
NYF308513363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty