Provider Demographics
NPI:1013134618
Name:FAULKNER, KELLEY M (DEM)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2445
Mailing Address - Country:US
Mailing Address - Phone:508-429-6663
Mailing Address - Fax:508-452-0111
Practice Address - Street 1:19 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2445
Practice Address - Country:US
Practice Address - Phone:508-429-6663
Practice Address - Fax:508-452-0111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife