Provider Demographics
NPI:1659139814
Name:CALLAHAN, KILEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST STE 8
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2158
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:
Practice Address - Street 1:110 W SQUANTUM ST STE 8
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2158
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316334163WC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine