Healthcare Provider Details

I. General information

NPI: 1396275640
Provider Name (Legal Business Name): REBECCA HUYS KESSEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE STE 106
NORWALK CT
06851-1080
US

IV. Provider business mailing address

761 MAIN AVE STE 106
NORWALK CT
06851-1080
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-8885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10146
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342647
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693415
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17748700
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number182918
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: