Healthcare Provider Details

I. General information

NPI: 1194490359
Provider Name (Legal Business Name): KAUSAR KHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HARTFORD TPKE
VERNON CT
06066-5037
US

IV. Provider business mailing address

520 HARTFORD TPKE
VERNON CT
06066-5037
US

V. Phone/Fax

Practice location:
  • Phone: 860-878-7314
  • Fax:
Mailing address:
  • Phone: 860-533-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9856
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: