Active NPI
Elizabeth Ellen Kennedy
- Adult Health Nurse Practitioner
- Boston, MA
National Provider Identifier
1124167861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 146061
- Practice address
- 75 Fenwood Rd.
Massachusetts Mental Health Center
Boston, MA 02115 - Phone
- (617) 626-9326
- Fax
- (617) 626-9578
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 146061 | MA | Primary |
Addresses
Primary practice location
75 Fenwood Rd.
Massachusetts Mental Health Center
Boston, MA 02115
Mailing address
2 Hammond PL
Medford, MA 02155-2232
Phone (781) 395-8616
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146061 | MA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1124167861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 HAMMOND PL",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021552232",
"telephone_number": "781-395-8616",
"fax_number": "617-626-9591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 FENWOOD RD.",
"address_2": "MASSACHUSETTS MENTAL HEALTH CENTER",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-626-9326",
"fax_number": "617-626-9578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "ELIZABETH",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MA",
"license": "146061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.