Katie A Creedon, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

252810 Issued in MA

Practice address

940 Belmont St
Brockton, MA 02301-5596

Phone

(774) 826-1866

NPI assigned

Aug 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Katie Macdonald Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1538350673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 FOREST DR",
            "city": "BRIDGEWATER",
            "state": "MA",
            "postal_code": "023242330",
            "telephone_number": "603-387-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 BELMONT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015596",
            "telephone_number": "774-826-1866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Forest Dr",
            "address_purpose": "LOCATION",
            "city": "Bridgewater",
            "state": "MA",
            "postal_code": "023242330",
            "country_code": "US",
            "telephone_number": "603-387-7684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CREEDON",
        "first_name": "KATIE",
        "middle_name": "A",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "252810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110077919A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "MACDONALD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jeanne-Marie Crespi, LICSW
• Allison Cretinon
• Peter J Crimmins, PT, DPT
• Rachael Lee Crimmins
• Lynda Cripps, NP

• Adult Health Nurse Practitioner in Brockton, MA
• Providers in Brockton, MA by specialty
• Adult Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.