Individual
KIMBERLY ANN OCALLAGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
545A CENTRE ST, JAMAICA PLAIN, MA 02130-2061
(617) 477-4929
(617) 522-0903
Mailing address
545A CENTRE ST, JAMAICA PLAIN, MA 02130-2061
(617) 477-4929
(617) 522-0903
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
167499
MA
363LA2200X
Adult Health Nurse Practitioner
167499
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0321451
—
MA
01
—
83-01261
EVERCARE
—
01
—
NP0604
BLUE SHIELD
—
01
—
P00456876
RAILROAD MEDICARE
—
Enumeration date
02/23/2006
Last updated
01/31/2013
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