Provider Demographics
NPI:1689642076
Name:ZAKAR, KELLY M (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:ZAKAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CIDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033-2058
Mailing Address - Country:US
Mailing Address - Phone:603-620-0284
Mailing Address - Fax:781-216-1503
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:603-620-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN216232363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020518021OtherONE HEALTH/GREAT WEST
NH020518021OtherUNITED HEALTHCARE
NH2375234OtherAETNA - HMO
NH23YP05288NH01OtherBLUE CROSS & BLUE SHIELD
NH4570918OtherAETNA - NON HMO
NH020518021OtherHCVM
NH30342638Medicaid
NH30914OtherHEALTHSOURCE
NH020518021OtherCIGNA
NHAA3765OtherHARVARD PILGRIM
NH020518021OtherUNITED HEALTHCARE