Kavanagh, Kenneth C

Kavanagh, Kenneth C is an individual health care provider with primary practice located at 780 Albany St , Boston MA 02118-2524. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Kavanagh, Kenneth C can be contacted via phone (857) 654-1600.

Contact Information

Primary practice address
780 Albany St Boston MA 02118-2524
Phone: (857) 654-1600
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X ARNP9200934 Florida
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X ARNP9200934 Florida
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 213555 Massachusetts
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 213555 Massachusetts

Profile Details

NPI number 1699825919
LBN Legal business name Kavanagh, Kenneth C
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Dec 12th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699825919 NPPES
Florida MEDICAID 305613900
Florida Other Y124U

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