Healthcare Provider Details

I. General information

NPI: 1245539873
Provider Name (Legal Business Name): KATHLEEN OBUCHON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 06/26/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 FARMINGTON AVENUE
BRISTOL CT
06010
US

IV. Provider business mailing address

120 W MAIN ST
PLAINVILLE CT
06062-1944
US

V. Phone/Fax

Practice location:
  • Phone: 860-584-4535
  • Fax: 860-584-4535
Mailing address:
  • Phone: 860-747-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003228
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: