Provider Demographics
NPI:1053373688
Name:MCFEETERS, KERRIE (NP)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:MCFEETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST FL ST12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-898-2338
Mailing Address - Fax:508-366-9938
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5408
Practice Address - Country:US
Practice Address - Phone:508-898-2338
Practice Address - Fax:508-366-9938
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN250715363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073093AMedicaid
MA110073093AMedicaid