Provider Demographics
NPI:1457351017
Name:OCONNOR, KATHLEEN MARY (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-0355
Mailing Address - Country:US
Mailing Address - Phone:860-464-7253
Mailing Address - Fax:860-464-7404
Practice Address - Street 1:1527 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1800
Practice Address - Country:US
Practice Address - Phone:860-464-7253
Practice Address - Fax:860-464-7404
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002732207R00000X, 363LP2300X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
400002732C703OtherBCBS
020732OtherCT CARE
2V6457OtherHEALTHNET
020732OtherCT CARE
2V6457OtherHEALTHNET