MS. KALLY ANN PETKA (NPI# 1548892326) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548892326 |
| Entity Type | Individual |
| Full Name | MS. KALLY ANN PETKA |
| Credential | FNP |
| Practice Address |
100 South St Southbridge MA 01550-4051 |
| Mailing Address |
100 South St Ste 1 Southbridge MA 01550-4047 |
| Practice Telephone | 5087659771 |
| Mailing Telephone | 5087659771 |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2020-02-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN2277628 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
100 SOUTH ST |
| City | SOUTHBRIDGE |
| State | MA |
| Zip Code | 01550-4051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720089063 | John Michael Tumolo | Internal Medicine | 100 South St, Suite 104, Southbridge, MA 01550-4051 | 2005-08-09 |
| 1093316473 | Julianne Brechtl | Counselor | 100 South St, Southbridge, MA 01550-4051 | 2020-11-03 |
| 1164029971 | Teesha Marie Carrasquillo | Social Worker | 100 South St, Southbridge, MA 01550-4051 | 2020-10-05 |
| 1851927347 | Brittany Moreau | Dietitian, Registered | 100 South St, Southbridge, MA 01550-4051 | 2020-03-17 |
| 1497309694 | Laurette E Mcdonald | Registered Nurse | 100 South St, Southbridge, MA 01550-4051 | 2019-07-26 |
| 1033775697 | Cydney Weiner | Physician Assistant | 100 South St, Southbridge, MA 01550-4051 | 2019-05-18 |
| 1245896281 | Heather Lynn Bingham | Counselor | 100 South St, Southbridge, MA 01550-4051 | 2019-05-15 |
| 1982165056 | Imaging Consultants Inc | Clinic/Center | 100 South St, Southbridge, MA 01550-4051 | 2019-03-29 |
| 1609345099 | Alyssa Rose Mitchell | Physician Assistant | 100 South St, Southbridge, MA 01550-4051 | 2018-11-15 |
| 1134604291 | Michaela White | Dietitian, Registered | 100 South St, Southbridge, MA 01550-4051 | 2018-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033726765 | Nathanael Lopez | Counselor | 328 Main St Apt #1, Southbridge, MA 01550 | 2020-09-27 |
| 1356969497 | Sarah Anne Mcnulty | Registered Nurse | Harrington Hospital, 100 South Street, Southbridge, MA 01550 | 2020-07-06 |
| 1699316406 | Adrienne Ellen Soucy | Developmental Therapist | Kennedy Donovan Center, 486 Worcester St., Southbridge, MA 01550 | 2019-10-02 |
| 1184101610 | Charles D Fraser | Nurse Practitioner | 657 Worcester St Apt 204, Southbridge, MA 01550 | 2018-07-26 |
| 1689160954 | Christine Ann Surrette | Nurse Practitioner | 11 Sandersdale Rd, Southbridge, MA 01550 | 2018-07-10 |
| 1528560075 | Danielle Torre Aspinwall | Physician Assistant | 100 South Street Suite 208, Southbridge, MA 01550 | 2018-03-01 |
| 1215455829 | New Beginnings of Southbridge | Marriage & Family Therapist | 146 Ashland Ave Suite B, Southbridge, MA 01550 | 2017-09-03 |
| 1902323835 | Shannon Paisley | Counselor | 328 Main St. #1, Southbridge, NY 01550 | 2017-08-22 |
| 1811300023 | Mary Dayotas | Counselor | 176 Main St., Southbridge, MA 01550 | 2014-06-05 |
| 1962752121 | You Inc | Community/Behavioral Health | 238 Main Street, Southbridge, MA 01550 | 2012-09-14 |
| Find all providers in zip 01550 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073040721 | Paulette Remijan | Nurse Practitioner | 100 South St, Comprecare, Southbridge, MA 01550-4051 | 2017-05-12 |
| 1861896839 | Darius Michael Parker Taylor | Nurse Practitioner | 100 South Street, Southbridge, MA 01550-4051 | 2014-10-20 |
| 1801132295 | Darleny Henriquez | Nurse Practitioner | 100 South St, Southbridge, MA 01550-4051 | 2012-12-12 |
| 1437216546 | Kathryn Edith Swanson | Nurse Practitioner | 222 Main Street, Southbridge, MA 01550-2593 | 2007-01-02 |
| 1891804472 | Patricia A Kent | Nurse Practitioner | 100 South St, Southbridge, MA 01550-4051 | 2006-08-29 |
| 1801860895 | Pamela D. Kutzer | Nurse Practitioner | 100 South St, Southbridge, MA 01550-4051 | 2006-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497356893 | Alanna Rose Atkinson | Nurse Practitioner | 721 Newport Ave Apt 2, Attleboro, MA 02703-5932 | 2020-11-03 |
| 1770182230 | Elizabeth Anne Sutera | Nurse Practitioner | 725 Concord Ave Ste 3200, Cambridge, MA 02138-1092 | 2020-10-25 |
| 1962001503 | Dana Pallotta | Nurse Practitioner | 43 Saint Dennis Dr, Westwood, MA 02090-1820 | 2020-10-24 |
| 1194332577 | Andrew Wenstrom | Nurse Practitioner | 12 Hemlock St, Norwood, MA 02062-5616 | 2020-09-29 |
| 1801403290 | Jennifer Stewart | Nurse Practitioner | 16 Stonehedge Dr, Wilmington, MA 01887-3191 | 2020-09-29 |
| 1366058463 | Alexandra Paz | Nurse Practitioner | 55 Dartmouth St, Boston, MA 02116-5906 | 2020-09-23 |
| 1225644420 | Jodi M Thompson | Nurse Practitioner | 11 Otis St, Lynn, MA 01904-1816 | 2020-09-22 |
| 1730795238 | Eun Chung Hong | Nurse Practitioner | 2 Sheldon St Apt 1, Boston, MA 02131-2613 | 2020-09-20 |
| 1902411002 | Eva Fiona Muhanuka | Nurse Practitioner | 21 Fillmore Dr, Billerica, MA 01821-2103 | 2020-09-15 |
| 1306450309 | Latoya Browne | Nurse Practitioner | 33 Taunton Ave, Boston, MA 02136-6027 | 2020-09-07 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHBRIDGE |
| Zip Code | 01550 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.