Provider Demographics
NPI:1003922345
Name:DANIELS, KARI JO (PA-C MPAS)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:JO
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PA-C MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 TALCOTTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-871-2016
Mailing Address - Fax:860-871-9329
Practice Address - Street 1:561 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2311
Practice Address - Country:US
Practice Address - Phone:860-871-2016
Practice Address - Fax:860-871-9329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000840363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS71704Medicare UPIN
CT970000329Medicare ID - Type Unspecified
CO3298Medicare PIN