Stephenson, Kerry Rose

Stephenson, Kerry Rose is an individual health care provider with primary practice located at 575 Main St Fl 2 Attn: Credentialing Dpt, Middletown CT 06457-2845. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Stephenson, Kerry Rose can be contacted via phone (860) 347-6971.

Contact Information

Primary practice address
575 Main St Fl 2 Attn: Credentialing Dpt Middletown CT 06457-2845
Phone: (860) 347-6971
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 003654 Connecticut

Profile Details

NPI number 1497944425
LBN Legal business name Stephenson, Kerry Rose
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2007
Last updated Feb 9th, 2012 - 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 1497944425 NPPES
Connecticut MEDICAID 004236338

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