Provider Demographics
NPI:1841688553
Name:DAWSON, KEONA (APRN)
Entity type:Individual
Prefix:
First Name:KEONA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4643
Mailing Address - Country:US
Mailing Address - Phone:860-482-3038
Mailing Address - Fax:
Practice Address - Street 1:469 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4643
Practice Address - Country:US
Practice Address - Phone:860-482-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5941363LA2200X
CT005941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1356318091Medicaid