Healthcare Provider Details

I. General information

NPI: 1396570206
Provider Name (Legal Business Name): KATHRYN ALEXIS LEONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATHRYN ALEXIS HEWITT

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 11/16/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE
GLASTONBURY CT
06033-2421
US

IV. Provider business mailing address

28 SECOND AVE UNIT 2
WEST HAVEN CT
06516-5116
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-3376
  • Fax:
Mailing address:
  • Phone: 203-993-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13786
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: