Provider Demographics
NPI:1477026201
Name:MCCOOTY-LAWRENCE, KERRYANN (APRN)
Entity type:Individual
Prefix:
First Name:KERRYANN
Middle Name:
Last Name:MCCOOTY-LAWRENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KERRY-ANN
Other - Middle Name:
Other - Last Name:DALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:185 ASYLUM ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-3408
Mailing Address - Country:US
Mailing Address - Phone:860-861-1357
Mailing Address - Fax:
Practice Address - Street 1:185 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-3408
Practice Address - Country:US
Practice Address - Phone:860-861-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT99969163WH0200X
CT11439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health