Provider Demographics
NPI:1710234448
Name:KHONGDY, AERICKA ROBYN (APRN)
Entity Type:Individual
Prefix:
First Name:AERICKA
Middle Name:ROBYN
Last Name:KHONGDY
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 1:120 WEBSTER SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2329
Mailing Address - Country:US
Mailing Address - Phone:860-829-0707
Mailing Address - Fax:860-829-0606
Practice Address - Street 1:320 WESTERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1276
Practice Address - Country:US
Practice Address - Phone:860-657-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005063363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health