Provider Demographics
NPI:1720144736
Name:BELMONTE, KATHLEEN ANNE (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:BELMONTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:BELMONTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:186 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6517
Mailing Address - Country:US
Mailing Address - Phone:781-718-8902
Mailing Address - Fax:
Practice Address - Street 1:186 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6517
Practice Address - Country:US
Practice Address - Phone:781-718-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213307NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342271Medicaid
MA0342271Medicaid