Provider Demographics
NPI:1528415833
Name:HUKILL, KELSEY E (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:HUKILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1828
Mailing Address - Country:US
Mailing Address - Phone:860-372-4990
Mailing Address - Fax:
Practice Address - Street 1:396 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1828
Practice Address - Country:US
Practice Address - Phone:860-372-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3565OtherCT STATE LICENSING