Healthcare Provider Details

I. General information

NPI: 1316497662
Provider Name (Legal Business Name): KELLY HEILMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 NEW LONDON TPKE STE 101
GLASTONBURY CT
06033-2246
US

IV. Provider business mailing address

131 NEW LONDON TPKE STE 101
GLASTONBURY CT
06033-2246
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-8904
  • Fax: 860-246-5828
Mailing address:
  • Phone: 860-659-8904
  • Fax: 860-246-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6739
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: