Healthcare Provider Details

I. General information

NPI: 1093324873
Provider Name (Legal Business Name): KAITLIN JEANNE O'CONNOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN JEANNE HICKS

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 11/18/2022
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE ICU, UNIVERSITY TOWER, 1ST FLOOR, MAIL CODE: 1131
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

263 FARMINGTON AVE ICU, UNIVERSITY TOWER, 1ST FLOOR, MAIL CODE: 1131
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3107
  • Fax: 860-679-1843
Mailing address:
  • Phone: 860-679-3107
  • Fax: 860-679-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number008994
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number008994
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: