MEDICARE: KERRYANN MCCOOTY-LAWRENCE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11439	CT
2	163WH0200X	Home Health Registered Nurse	99969	CT

General Provider Information

NPI Number	:	1477026201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRYANN MCCOOTY-LAWRENCE APRN

Provider Business Mailing Address
First Line	:	185 ASYLUM ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06103-3408
Country	:	US
Telephone Number	:	860-861-1357
Fax Number	:	855-714-2289

Provider Business Practice Location Address
First Line	:	185 ASYLUM ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06103-3408
Country	:	US
Telephone Number	:	860-861-1357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	04/29/2026

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