Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 722128 | TX |
Y | 363LC1500X | Nurse Practitioner - Community Health | RN258399 | MA |
NPI | 1194770289 |
---|---|
Provider Name | Kia J. Mccarthy |
First Address | Southborough, MA 01772-2108 |
Second Address | Southborough, MA 01772-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q59551 | (02) | TX |