Provider Demographics
NPI:1801802756
Name:NELSON, KATHRYN (APRN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:679 RAYMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382
Mailing Address - Country:US
Mailing Address - Phone:860-848-1821
Mailing Address - Fax:860-848-9460
Practice Address - Street 1:355 HIGH STREET
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226
Practice Address - Country:US
Practice Address - Phone:860-465-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 000367207QA0000X, 2080A0000X
CT000367363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine