Individual provider Active NPI

Kenneth Mutegyeki, RN BSN

  • Nurse Practitioner
  • Milford, MA
National Provider Identifier
1487410999
Registry record updated Apr 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2267715 Issued in MA
Practice address
58 Haven St
Milford, MA 01757-3821
Phone
(508) 933-1804
NPI assigned
Feb 22, 2024
Last updated
Apr 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2267715 MA Primary

Addresses

Primary practice location

58 Haven St
Milford, MA 01757-3821

Mailing address

58 Haven St
Milford, MA 01757-3821
Phone (508) 933-1804

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260501001109 MA Practitioner - Nurse Practitioner 1951879550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

31 Granite St
Suite 2
Milford, MA 01757-1695

58 Haven St
Milford, MA 01757-3821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN2267715MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Shift Wellness Clinic LLC Nurse Practitioner CurrentSince Mar 26, 2026 Accepting new patients

Locations

31 Granite St
Ste 2
Milford, MA 01757
Phone (508) 933-1804

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1708560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777075200000",
    "number": "1487410999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 HAVEN ST",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017573821",
            "telephone_number": "508-933-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 HAVEN ST",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017573821",
            "telephone_number": "508-933-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTEGYEKI",
        "first_name": "KENNETH",
        "credential": "RN BSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-22",
        "last_updated": "2026-04-25",
        "certification_date": "2026-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2267715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, MA

Sources for this page

Verify at the official NPI Registry.