Healthcare Provider Details

I. General information

NPI: 1457290843
Provider Name (Legal Business Name): SHANNON KATHLEEN PADGETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE
HARTFORD CT
06106-3309
US

IV. Provider business mailing address

200 RETREAT AVE
HARTFORD CT
06106-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7909
  • Fax: 860-545-7650
Mailing address:
  • Phone: 860-545-7909
  • Fax: 860-545-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17708
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: