Healthcare Provider Details

I. General information

NPI: 1346659778
Provider Name (Legal Business Name): CATHY KIERNOZEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 11/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CAPITAL BLVD
ROCKY HILL CT
06067-3576
US

IV. Provider business mailing address

345 WINDING RDG
SOUTHINGTON CT
06489-2180
US

V. Phone/Fax

Practice location:
  • Phone: 860-221-0549
  • Fax: 855-247-8787
Mailing address:
  • Phone: 860-839-0781
  • Fax: 855-232-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5818
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5818
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: