Individual provider Active NPI

Jessica S Lally

  • Pediatric Nurse Practitioner
  • Brookline, MA
National Provider Identifier
1700793643
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN2354902 Issued in MA
Practice address
50 Park St Apt 24
Brookline, MA 02446-6200
Phone
(401) 585-4119
NPI assigned
Aug 26, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN2354902 MA Primary

Addresses

Primary practice location

50 Park St Apt 24
Brookline, MA 02446-6200

Mailing address

50 Park St Apt 24
Brookline, MA 02446-6200
Phone (401) 585-4119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1787702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1700793643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PARK ST APT 24",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024466200",
            "telephone_number": "401-585-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PARK ST APT 24",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024466200",
            "telephone_number": "401-585-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLY",
        "first_name": "JESSICA",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-08-26",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2354902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.