Healthcare Provider Details

I. General information

NPI: 1407767254
Provider Name (Legal Business Name): KAYE-LONI NICHOLE JOHNSON APRN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RIVER RD
MIDDLETOWN CT
06457-3921
US

IV. Provider business mailing address

915 RIVER RD
MIDDLETOWN CT
06457-3921
US

V. Phone/Fax

Practice location:
  • Phone: 860-704-4056
  • Fax:
Mailing address:
  • Phone: 860-704-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number212234
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: