Individual
KENNETH C KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
780 ALBANY ST, BOSTON, MA 02118-2524
(857) 654-1600
Mailing address
780 ALBANY ST, BOSTON, MA 02118-2524
(857) 654-1600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
ARNP9200934
FL
363LA2200X
Adult Health Nurse Practitioner
213555
MA
363LA2200X
Adult Health Nurse Practitioner
ARNP9200934
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
213555
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305613900
—
FL
01
—
Y124U
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/11/2007
Last updated
12/12/2012
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