Provider Demographics
NPI:1447558374
Name:CAFASSO, KERRY A (NP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:CAFASSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:64 WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-2112
Mailing Address - Country:US
Mailing Address - Phone:617-312-5132
Mailing Address - Fax:617-389-2334
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY BUILDING, SUITE 4B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-6700
Practice Address - Fax:617-724-6725
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANP263817363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health