Provider Demographics
NPI:1528579257
Name:DEVEJIAN, KATHLEEN NELLIE (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NELLIE
Last Name:DEVEJIAN
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 STAGE ROAD, PO BOX 458,
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841
Mailing Address - Country:US
Mailing Address - Phone:603-329-5222
Mailing Address - Fax:888-927-0461
Practice Address - Street 1:207 STAGE ROAD, PO BOX 458,
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841
Practice Address - Country:US
Practice Address - Phone:603-329-5222
Practice Address - Fax:888-927-0461
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN203026363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty