Healthcare Provider Details

I. General information

NPI: 1194033738
Provider Name (Legal Business Name): KATE FELTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS CV SUITE 205
NEW LONDON CT
06320-4956
US

IV. Provider business mailing address

7 ATWOOD DR
NIANTIC CT
06357-1001
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-2377
  • Fax:
Mailing address:
  • Phone: 203-314-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: