Provider Demographics
NPI:1801955091
Name:COULOMBE, KATHLEEN H (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:COULOMBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:164 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 HIGH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2613
Practice Address - Country:US
Practice Address - Phone:413-774-2222
Practice Address - Fax:413-774-2225
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA202253144OtherUNITED HEALTHCARE
MANP5533OtherBLUE CROSS BLUE SHIELD
MA1801955091OtherTRI CARE
MA9749811Medicaid
MA9749811Medicaid