MEDICARE: PATRICIA STORK KILCULLEN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	002016	CT
2	363LA2200X	Adult Health Nurse Practitioner	F302513-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	500001411	OTHER		UNSPECIFIED

General Provider Information

NPI Number	:	1316940190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA STORK KILCULLEN APRN

Provider Business Mailing Address
First Line	:	4 STURDEVANT DR
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06811-3543
Country	:	US
Telephone Number	:	203-748-5754
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 BRADHURST AVE
Second Line	:
City	:	HAWTHORNE
State	:	NY
Zip	:	10532-2140
Country	:	US
Telephone Number	:	914-493-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/16/2015

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