Provider Demographics
NPI:1396254470
Name:BOULEY, KAITLIN (MS, CNP, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:BOULEY
Suffix:
Gender:F
Credentials:MS, CNP, AGNP-C
Other - Prefix:MISS
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:CHESNULEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RN
Mailing Address - Street 1:471 OSGOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3436
Mailing Address - Country:US
Mailing Address - Phone:603-718-5936
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVAN ST STE B102
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2764
Practice Address - Country:US
Practice Address - Phone:888-283-1722
Practice Address - Fax:978-774-4389
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN271153363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health