Healthcare Provider Details

I. General information

NPI: 1407370976
Provider Name (Legal Business Name): AUDREY MAUREEN KEMP AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ASYLUM ST
HARTFORD CT
06103-3408
US

IV. Provider business mailing address

8 WILDFLOWER DR
HEBRON CT
06248-1449
US

V. Phone/Fax

Practice location:
  • Phone: 860-573-8625
  • Fax:
Mailing address:
  • Phone: 860-655-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1002565
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: