Provider Demographics
NPI:1588477640
Name:DRISCOLL, KAITLIN (FNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CEDRIC RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2000
Mailing Address - Country:US
Mailing Address - Phone:774-532-2169
Mailing Address - Fax:
Practice Address - Street 1:118 CEDRIC RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2000
Practice Address - Country:US
Practice Address - Phone:774-532-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10006306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner