Provider Demographics
NPI:1104282136
Name:AMMON, KATHLEEN (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:AMMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:50 ROWE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3201
Mailing Address - Country:US
Mailing Address - Phone:781-665-6606
Mailing Address - Fax:781-665-1277
Practice Address - Street 1:50 ROWE ST STE 400
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3201
Practice Address - Country:US
Practice Address - Phone:781-665-6606
Practice Address - Fax:781-665-1277
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278892363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology