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General NPI Number Information
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NPI Number | 1255053971
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Entity Type | Organization
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Legal Business Name | KIND COMPASSIONATE RELIEF KCR
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 925 SULLIVAN AVE STE 2
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2080
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Country | US
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Telephone | 201-982-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 925 SULLIVAN AVE STE 2
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2080
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Country | US
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Telephone | 201-982-3828
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KHUSHBOO SURTI
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Credential | APRN
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Telephone | 201-982-3828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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