Kellieanne T Boutilier, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

274450 Issued in MA

Practice address

127 Plympton St
Middleboro, MA 02346-2609

Phone

(508) 946-6906

NPI assigned

Jun 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992902316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PLYMPTON ST",
            "city": "MIDDLEBORO",
            "state": "MA",
            "postal_code": "023462609",
            "telephone_number": "508-946-6906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 PLYMPTON ST",
            "city": "MIDDLEBORO",
            "state": "MA",
            "postal_code": "023462609",
            "telephone_number": "508-946-6906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTILIER",
        "first_name": "KELLIEANNE",
        "middle_name": "T",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "274450",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "RI",
            "license": "RN44317",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alfred M Bongiorno, DMD
• Meghan A Brant
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• Gedeon Brezil, LCSW
• Lia M Brossi

• All providers in Middleboro, MA
• Registered Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.