Provider Demographics
NPI:1588704522
Name:KERRIGAN, KIMBERLY ALLEN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALLEN
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-4713
Mailing Address - Country:US
Mailing Address - Phone:781-891-2222
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4713
Practice Address - Country:US
Practice Address - Phone:781-891-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2311625363LF0000X
CA392220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily