Healthcare Provider Details

I. General information

NPI: 1891628749
Provider Name (Legal Business Name): KATHRYN TERESE PENNINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BURNSIDE AVE
EAST HARTFORD CT
06108-3408
US

IV. Provider business mailing address

26 HAMPTON DR
MANCHESTER CT
06040-6765
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-0975
  • Fax:
Mailing address:
  • Phone: 860-614-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number073673
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: