Healthcare Provider Details

I. General information

NPI: 1083199764
Provider Name (Legal Business Name): KEMMARIE BEAL, NP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BROAD ST STE 304
WINDSOR CT
06095-3030
US

IV. Provider business mailing address

340 BROAD ST STE 304
WINDSOR CT
06095-3030
US

V. Phone/Fax

Practice location:
  • Phone: 860-776-0187
  • Fax: 815-205-4087
Mailing address:
  • Phone: 860-776-0187
  • Fax: 815-205-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEMMARIE BEAL
Title or Position: OWNER
Credential: NP
Phone: 860-966-0141