Provider Demographics
NPI:1396570206
Name:LEONE, KATHRYN ALEXIS (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ALEXIS
Last Name:LEONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ALEXIS
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 SECOND AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5116
Mailing Address - Country:US
Mailing Address - Phone:203-993-5530
Mailing Address - Fax:
Practice Address - Street 1:622 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2421
Practice Address - Country:US
Practice Address - Phone:860-657-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13786363LF0000X
CT12.013786207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily