Provider Demographics
NPI:1659267003
Name:EAGEN, KELLY DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:EAGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35 S HUNTINGTON AVE UNIT 409
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4787
Mailing Address - Country:US
Mailing Address - Phone:860-918-8129
Mailing Address - Fax:
Practice Address - Street 1:35 S HUNTINGTON AVE UNIT 409
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4787
Practice Address - Country:US
Practice Address - Phone:860-918-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant