Provider Demographics
NPI:1700582632
Name:GAFFNEY, KATHRYN JANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CHURCH ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1760
Mailing Address - Country:US
Mailing Address - Phone:203-914-5552
Mailing Address - Fax:
Practice Address - Street 1:45 CHURCH ST APT 3J
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1760
Practice Address - Country:US
Practice Address - Phone:203-914-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8809363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care