Healthcare Provider Details

I. General information

NPI: 1467867416
Provider Name (Legal Business Name): KARA ANN EMMETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEWELL RD STE E36
BRISTOL CT
06010-5132
US

IV. Provider business mailing address

25 NEWELL RD STE E36
BRISTOL CT
06010-5132
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-9252
  • Fax:
Mailing address:
  • Phone: 860-583-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number005761
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5671
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: