Active NPI
Kathleen Keenan, NP
- Nurse Practitioner
- Boston, MA
National Provider Identifier
1184784050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 119680
- Practice address
- 55 Fruit Street VBK 3
Boston, MA 02114-2696 - Phone
- (617) 726-5544
- NPI assigned
- Dec 11, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 119680 | MA | Primary |
Addresses
Primary practice location
55 Fruit Street VBK 3
Boston, MA 02114-2696
Mailing address
PO Box 9142
Mass General Physicians Organization Inc
Charlestown, MA 02129-9142
Phone (617) 724-0287
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0700801 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150408000151 | MA | Order and Referring Only - Nurse Practitioner | 3072574060 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184784050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9142",
"address_2": "MASS GENERAL PHYSICIANS ORGANIZATION INC",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021299142",
"telephone_number": "617-724-0287",
"fax_number": "617-726-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT STREET VBK 3",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142696",
"telephone_number": "617-726-5544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEENAN",
"first_name": "KATHLEEN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "119680",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0700801",
"state": "MA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.