Healthcare Provider Details

I. General information

NPI: 1073190120
Provider Name (Legal Business Name): KELLY ANN MCKENNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 SILAS DEANE HWY
WETHERSFIELD CT
06109-4227
US

IV. Provider business mailing address

17 BROOKHAVEN LN
SOUTH WINDSOR CT
06074-3583
US

V. Phone/Fax

Practice location:
  • Phone: 860-493-1950
  • Fax:
Mailing address:
  • Phone: 860-951-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number85782
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: