Marietta Kenyan

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN2266809 Issued in MA

Practice address

55 Lake Ave N
Worcester, MA 01655-0002

Phone

(508) 334-0689

Fax

(508) 856-3981

NPI assigned

Sep 28, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1487024980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-0689",
            "fax_number": "508-856-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENYAN",
        "first_name": "MARIETTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2266809",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2266809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick M Kenny, CPO
• David A Kent, PSY.D.
• Kevin Kent, M.D.
• Lily Isabella Kent, PA-C
• Kristy Kenworthy, RDN
• Julia B Kenyon
• Lori Ann Keough
• Kepa Home Care, LLC
• Farzaneh Esther Kermani
• Elizabeth Kern, CNP

• Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.