Provider Demographics
NPI:1326376898
Name:NETTLETON, KATHRYN ORA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ORA
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ORA
Other - Last Name:MASCHKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1 ROYCE CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2260
Mailing Address - Country:US
Mailing Address - Phone:860-487-9200
Mailing Address - Fax:860-487-9222
Practice Address - Street 1:1 ROYCE CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2260
Practice Address - Country:US
Practice Address - Phone:860-487-9200
Practice Address - Fax:860-487-9222
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical