Provider Demographics
NPI:1942597661
Name:O'BRIEN, KATHLEEN IRENE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:IRENE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1768
Mailing Address - Country:US
Mailing Address - Phone:207-406-7600
Mailing Address - Fax:207-618-5683
Practice Address - Street 1:1 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1768
Practice Address - Country:US
Practice Address - Phone:207-406-7600
Practice Address - Fax:207-618-5683
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1272363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002375502Medicare PIN