Provider Demographics
NPI:1548451156
Name:O'CONNOR, KERRY LEE (NP)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LEE
Last Name:O'CONNOR
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 1:120 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1223
Mailing Address - Country:US
Mailing Address - Phone:508-756-7176
Mailing Address - Fax:508-792-4927
Practice Address - Street 1:120 THOMAS ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1223
Practice Address - Country:US
Practice Address - Phone:508-756-7176
Practice Address - Fax:508-792-4927
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192280363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health