Provider Demographics
NPI:1093324873
Name:O'CONNOR, KAITLIN JEANNE (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JEANNE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:JEANNE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:ICU, UNIVERSITY TOWER, 1ST FLOOR, MAIL CODE: 1131
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-3107
Mailing Address - Fax:860-679-1843
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:ICU, UNIVERSITY TOWER, 1ST FLOOR, MAIL CODE: 1131
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-3107
Practice Address - Fax:860-679-1843
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008994363LC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine