Provider Demographics
NPI:1851383434
Name:KENNEDY, GERALDINE (MS RN FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS RN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 CAREW ST
Mailing Address - Street 2:MERCY MEDICAL CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2377
Mailing Address - Country:US
Mailing Address - Phone:413-748-9063
Mailing Address - Fax:413-748-9049
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:MERCY MEDICAL CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9063
Practice Address - Fax:413-748-9049
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA142162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0377091Medicaid
MANP3474Medicare UPIN