Provider Demographics
NPI:1659196590
Name:MANCINELLI-HOUGH, KIMBERLY (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MANCINELLI-HOUGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:MANCINELLI-HOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:43 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2004
Mailing Address - Country:US
Mailing Address - Phone:413-427-2526
Mailing Address - Fax:
Practice Address - Street 1:43 CRANE RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2004
Practice Address - Country:US
Practice Address - Phone:413-427-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily