Healthcare Provider Details

I. General information

NPI: 1972491876
Provider Name (Legal Business Name): KENITRA LACHELLE SHERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N MAIN ST
BRISTOL CT
06010-1938
US

IV. Provider business mailing address

943 BUNKER HILL AVE
WATERBURY CT
06708-1503
US

V. Phone/Fax

Practice location:
  • Phone: 475-263-2946
  • Fax: 203-547-8011
Mailing address:
  • Phone: 475-263-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number014974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: