Jack, Kathryn E

Jack, Kathryn E is an individual health care provider with primary practice located at 455 Lewis Ave Suite 106, Meriden CT 06451-2121. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Jack, Kathryn E can be contacted via phone (203) 886-0036.

Contact Information

Primary practice address
455 Lewis Ave Suite 106 Meriden CT 06451-2121
Phone: (203) 886-0036
Fax: (203) 886-0072
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 002455 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 002455 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 002455 Connecticut

Profile Details

NPI number 1265456347
LBN Legal business name Jack, Kathryn E
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2006
Last updated Nov 5th, 2013 - 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 1265456347 NPPES
Connecticut MEDICAID 004219491

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