Basic Information
| Provider Information | |||||||||
| NPI: | 1962543793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLOGG | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 MORRILL PL STE 2 | ||||||||
| Address2: | |||||||||
| City: | AMESBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019133530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788348074 | ||||||||
| FaxNumber: | 9788348077 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 PRIMROSE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018302659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785561000 | ||||||||
| FaxNumber: | 9785560101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 163778 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 30342198 | 05 | NH | MEDICAID | 0391930 | 05 | MA | MEDICAID |