Provider Demographics
NPI:1598526766
Name:KNOWLTON, KEVIN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SHAKER CT
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1256
Mailing Address - Country:US
Mailing Address - Phone:203-996-1099
Mailing Address - Fax:
Practice Address - Street 1:1591 BOSTON POST RD STE 100
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4335
Practice Address - Country:US
Practice Address - Phone:203-453-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.012787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily