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General NPI Number Information
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NPI Number | 1861107591
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Entity Type | Individual
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Provider Name | KERISHA S PRINCE
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Gender | Female
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 1022 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2105
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Country | US
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Telephone | 860-521-8035
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Fax | 860-521-8036
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Provider Business Mailing Address
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Address Line | 92 CHENEY LN
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City | EAST HARTFORD
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State | CT
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Zip | 06118-3005
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Country | US
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Telephone | 718-501-9840
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 011413
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 153956
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License Number State | CT
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