Kathleen Ellis Buckley, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN204319 Issued in MA

Practice address

3088 Cranberry Hwy Ste a
East Wareham, MA 02538-4800

Phone

(508) 295-7990

Fax

(508) 295-3117

NPI assigned

Apr 12, 2022

Last updated

Apr 12, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Habit Opco, LLC

  dba Habit OPCO- Springfield

  • Methadone Clinic
  • Springfield, MA
  • NPI 1023175072
  NPD (past)
• Habit Opco, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fitchburg, MA
  • NPI 1255034880
  NPD (past)

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1730821422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3088 CRANBERRY HWY STE A",
            "city": "EAST WAREHAM",
            "state": "MA",
            "postal_code": "025384800",
            "telephone_number": "508-295-7990",
            "fax_number": "508-295-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3088 CRANBERRY HWY STE A",
            "city": "EAST WAREHAM",
            "state": "MA",
            "postal_code": "025384800",
            "telephone_number": "508-295-7990",
            "fax_number": "508-295-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "KATHLEEN",
        "middle_name": "ELLIS",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "MA",
            "license": "RN204319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Ballert
• Adrianna Baptista
• Amanda Marie Bellew
• Jennifer Stacy Borelli, LMHC
• Jodi Anne Burgess, MSPT
• Dorothy Butler, LMHC
• Catherine Allison Cameron
• Laryzza Cardoza
• Elizabeth Anne Carroll

• Administrator Registered Nurse in East Wareham, MA
• Providers in East Wareham, MA by specialty
• Administrator Registered Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.