Provider Demographics
NPI:1710269725
Name:ROCHE, KAITLIN ADAMS (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ADAMS
Last Name:ROCHE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ANNETTE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:675 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2632
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:860-343-7379
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2632
Practice Address - Country:US
Practice Address - Phone:860-347-6971
Practice Address - Fax:860-343-7379
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247872Medicaid