Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN2269814 | MA |
NPI | 1003248204 |
---|---|
Provider Name | Kelly Lynn Kennedy |
First Address | Brookline, MA 02445-4485 |
Second Address | Natick, MA 01760-4310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 28/10/2019 |