Kim A Connolly, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN155278 Issued in MA

Practice address

162 Cordaville Rd
Southborough, MA 01772-1838

Phone

(508) 229-8811

NPI assigned

Oct 28, 2016

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

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1790237469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 UNION ST FL 2",
            "address_2": "CHILD DEVELOPMENT UNIT",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017606089",
            "telephone_number": "508-650-7733",
            "fax_number": "508-650-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 CORDAVILLE RD",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017721838",
            "telephone_number": "508-229-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "KIM",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-28",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN155278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Cole, D.C.
• Kaelin Michele Coleman
• Kayleigh Lauren Comer
• Lynn Condon
• Sarah Conlin, MS., CCC-SLP, BCBA
• Nicole Erica Conrod, B.S.
• Stacie Lorraine Cook
• Ariana Coppola
• Janet Genevieve Couture (Moschella), PSY.D.
• Bridget Couture

• Pediatric Nurse Practitioner in Southborough, MA
• Providers in Southborough, MA by specialty
• Pediatric Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.