Healthcare Provider Details

I. General information

NPI: 1548046824
Provider Name (Legal Business Name): KAITLIN FRANCES HOLIHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 GRANDVIEW AVE
WATERBURY CT
06708-2509
US

IV. Provider business mailing address

139 CLAY ST
THOMASTON CT
06787-1412
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone: 860-919-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12309
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: