Provider Demographics
NPI:1659300416
Name:AFRICANO, KATHLEEN S (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:AFRICANO
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 1:17 OLD KINGS HWY S
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4522
Mailing Address - Country:US
Mailing Address - Phone:203-655-1559
Mailing Address - Fax:
Practice Address - Street 1:17 OLD KINGS HWY S
Practice Address - Street 2:SUITE 1-2
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4522
Practice Address - Country:US
Practice Address - Phone:203-655-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004201795Medicaid
CT004201795Medicaid
CTS47109Medicare UPIN