Kelly Derchi Russo

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN280616 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2696

Phone

(617) 726-1231

NPI assigned

Jul 2, 2024

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

State licenses

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1730925488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 MCDONALD FARM RD",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018801578",
            "telephone_number": "781-572-9263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERCHI RUSSO",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN280616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Joseph Derbort, PH.D.
• Ivana Araba-Yahan Derby, DMD
• Lilly Derby
• Sarah Derby, LICSW
• Shane Derby, RN
• Piper Derenoncourt, LCSW, MPH
• Victoria Marie Derevianko, MD
• Leighla Dergham
• Asunta Derienzo, LMHC
• Stephen Dering, PT

• Family Nurse Practitioner in Boston, MA
• Providers in Boston, MA by specialty
• Family Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.