Basic Information
| Provider Information | |||||||||
| NPI: | 1851436059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 INDUSTRIAL DRIVE ROGERS OUTPATIENT CENTER | ||||||||
| Address2: | MASHPEE FAMILY MEDICINE SUITE 100 | ||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084774282 | ||||||||
| FaxNumber: | 5085396134 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 INDUSTRIAL DRIVE ROGERS OUTPATIENT CENTER | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084774272 | ||||||||
| FaxNumber: | 5085396134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 148085 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.