Provider Demographics
NPI:1902976384
Name:O CALLAHAN, KATHLEEN ANNE (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:O CALLAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3711
Mailing Address - Country:US
Mailing Address - Phone:207-487-9244
Mailing Address - Fax:207-368-4213
Practice Address - Street 1:NORTHEAST PAIN MANAGEMENT
Practice Address - Street 2:1365 BROADWAY
Practice Address - City:BANGER
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-6226
Practice Address - Fax:207-992-2753
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MANP149141363LF0000X
MECNP141113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4250OtherBCBS
MAQ25656Medicare UPIN
MAQ25656Medicare UPIN