Provider Demographics
NPI:1790713147
Name:BAILEY, KERRIE L (NP)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:L
Last Name:BAILEY
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Gender:
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST. SUITE 406
Practice Address - Street 2:SEMC - DIGESTIVE DISEASE CENTER
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-462-5432
Practice Address - Fax:617-789-5049
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA202130174400000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No174400000XOther Service ProvidersSpecialist