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General NPI Number Information
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NPI Number | 1710902986
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Entity Type | Individual
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Provider Name | KENT J KILBOURN PA
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 148 EAST AVE SUITE 3D
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City | NORWALK
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State | CT
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Zip | 06851-5721
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Country | US
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Telephone | 203-853-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SEYMOUR ST STE 1003
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City | HARTFORD
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State | CT
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Zip | 06106-5529
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Country | US
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Telephone | 203-853-0003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 00902
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License Number State | CT
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