Provider Demographics
NPI:1609626795
Name:DEERY, KATHLEEN LAURA (AGNP)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:LAURA
Last Name:DEERY
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:DEERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP
Mailing Address - Street 1:28 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7204
Mailing Address - Country:US
Mailing Address - Phone:781-910-0259
Mailing Address - Fax:
Practice Address - Street 1:414 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4446
Practice Address - Country:US
Practice Address - Phone:781-821-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331556163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse