Provider Demographics
NPI:1851587208
Name:CARR, KATHLEEN E (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:CARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:MCCUMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:BOSTON CHILDREN'S HOSPITAL
Mailing Address - Street 2:300 LONGWOOD AVE, DEPARTMENT OF GASTROENTEROLOGY & NUTR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:508-295-8622
Mailing Address - Fax:508-295-4909
Practice Address - Street 1:BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:300 LONGWOOD AVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-7713
Practice Address - Fax:508-295-4909
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256294208000000X
MARNNP256294363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics