Healthcare Provider Details

I. General information

NPI: 1730864729
Provider Name (Legal Business Name): KELLY KOUZELIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DEVINE ST
NORTH HAVEN CT
06473-2195
US

IV. Provider business mailing address

6 DEVINE ST
NORTH HAVEN CT
06473-2195
US

V. Phone/Fax

Practice location:
  • Phone: 203-495-2410
  • Fax:
Mailing address:
  • Phone: 203-495-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number140534
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12219
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12219
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: