Provider Demographics
NPI:1639665243
Name:GANNON, KARA ANN (APRN)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:GANNON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:ANN
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051
Practice Address - Country:US
Practice Address - Phone:603-577-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067455-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner