Healthcare Provider Details

I. General information

NPI: 1831065382
Provider Name (Legal Business Name): AUDREY ANN ATKINSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

9795 JEFFERSON PKWY APT B2
ENGLEWOOD CO
80112-5965
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2579
  • Fax:
Mailing address:
  • Phone: 803-983-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15366
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: