Provider Demographics
NPI:1710927017
Name:KELLY, JOAN MARIE (MSN, ANP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:D1B02
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194173363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care