Provider Demographics
NPI:1851436059
Name:CARROLL, KATHLEEN MARY (NURSE PRACTITIONER)
Entity Type:Individual
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First Name:KATHLEEN
Middle Name:MARY
Last Name:CARROLL
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Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:5 INDUSTRIAL DRIVE ROGERS OUTPATIENT CENTER
Mailing Address - Street 2:MASHPEE FAMILY MEDICINE SUITE 100
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649
Mailing Address - Country:US
Mailing Address - Phone:508-477-4282
Mailing Address - Fax:508-539-6134
Practice Address - Street 1:5 INDUSTRIAL DRIVE ROGERS OUTPATIENT CENTER
Practice Address - Street 2:SUITE 100
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-477-4272
Practice Address - Fax:508-539-6134
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-05-28
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Provider Licenses
StateLicense IDTaxonomies
MA148085363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health