Provider Demographics
NPI:1326105990
Name:SAUCIER, KIMBERLY K (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:SAUCIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-0857
Mailing Address - Country:US
Mailing Address - Phone:860-517-8557
Mailing Address - Fax:860-351-5601
Practice Address - Street 1:58 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1993
Practice Address - Country:US
Practice Address - Phone:860-517-8557
Practice Address - Fax:860-351-5601
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003551363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
500002325Medicare PIN