Provider Demographics
NPI:1417432097
Name:PRIOR, KELLY KRUPA (APRN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KRUPA
Last Name:PRIOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:KRUPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4123
Mailing Address - Country:US
Mailing Address - Phone:860-513-8442
Mailing Address - Fax:
Practice Address - Street 1:1321 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4334
Practice Address - Country:US
Practice Address - Phone:860-245-9364
Practice Address - Fax:860-812-2130
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7869363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health