Provider Demographics
NPI:1962027813
Name:KENNY, KATELYN (NP-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRIGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2445
Mailing Address - Country:US
Mailing Address - Phone:857-307-5600
Mailing Address - Fax:
Practice Address - Street 1:100 BRIGHAM WAY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2445
Practice Address - Country:US
Practice Address - Phone:857-307-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN233086363LF0000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool