Provider Demographics
NPI:1992189690
Name:MCDERMOTT, KATY-LYN
Entity type:Individual
Prefix:
First Name:KATY-LYN
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3138
Mailing Address - Country:US
Mailing Address - Phone:781-520-9152
Mailing Address - Fax:781-233-6137
Practice Address - Street 1:30 NEW CROSSING RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:781-942-0606
Practice Address - Fax:781-942-4674
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2274282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily