KATHRYN E JACK (NPI# 1265456347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265456347 |
| Entity Type | Individual |
| Full Name | KATHRYN E JACK |
| Credential | APRN |
| Practice Address |
455 Lewis Ave Suite 106 Meriden CT 06451-2121 |
| Mailing Address |
2139 Silas Deane Hwy Rocky Hill CT 06067-2336 |
| Practice Telephone | 2038860036 |
| Practice Fax Number | 2038860072 |
| Mailing Telephone | 8602574131 |
| Mailing Fax Number | 8602574519 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2013-11-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 002455 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
002455 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
002455 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004219491 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083768642 | Kathryn B Jack | Counselor | 490 E Roosevelt Rd Ste 205, West Chicago, IL 60185-3901 | 2007-01-22 |
| Street Address |
455 LEWIS AVE SUITE 106 |
| City | MERIDEN |
| State | CT |
| Zip Code | 06451-2121 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710986898 | David M Sack | Internal Medicine | 455 Lewis Ave, Suite 105, Meriden, CT 06451-2121 | 2005-07-20 |
| 1740601665 | Katelyn Spence | Nurse Practitioner | 455 Lewis Ave, Suite 220, Meriden, CT 06451-2121 | 2013-12-18 |
| 1336491752 | Hartford Healthcare Medical Group, Inc | Urology | 455 Lewis Ave, Ste. 210, Meriden, CT 06451-2121 | 2012-10-09 |
| 1316227291 | Hartford Clinical Associates, PC | Urology | 455 Lewis Ave, Suite 210, Meriden, CT 06451-2121 | 2011-08-23 |
| 1265669089 | Madhavi Bhoomagoud | Internal Medicine | 455 Lewis Ave, Suite 105, Meriden, CT 06451-2121 | 2009-06-18 |
| 1982839247 | Connecticut Nephrology Associates LLC | Internal Medicine | 455 Lewis Ave, Suite 214, Meriden, CT 06451-2121 | 2009-05-15 |
| 1639316177 | Rafal Barczak | Surgery | 455 Lewis Ave, Meriden, CT 06451-2121 | 2009-01-20 |
| 1598919045 | Paul Pyo | Urology | 455 Lewis Ave, Suite 210, Meriden, CT 06451-2121 | 2008-11-11 |
| 1962654178 | Bluegrass Medicine & Nephrology, LLC | Clinic/Center | 455 Lewis Ave, Suite 214, Meriden, CT 06451-2121 | 2008-10-21 |
| 1366692691 | Aly Hemdan Abdalla | Internal Medicine | 455 Lewis Ave, Suite 206, Meriden, CT 06451-2121 | 2008-09-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225490055 | Great Hills LLC | Pharmacy | 152 Colony St Unit A, Meriden, CT 06451 | 2016-03-22 |
| 1659695344 | Dr. Bertolli Od & Associates LLC | Optometrist | 470 Lewis Avenue, C/o Sears Optical, Meriden, CT 06451 | 2010-03-24 |
| 1205086733 | Michelle Lavallee Dagostine | Psychiatry & Neurology | 455 Lewis Ave., Suite 221, Meriden, CT 06451 | 2008-09-20 |
| 1538212857 | Meriden Surgical Supply Inc | Prosthetic/Orthotic Supplier | 170 West Main Street, Meriden, CT 06451 | 2007-01-19 |
| 1922036920 | Lisa M Marvin Smith | Nurse Practitioner | 26 Womens Way, Meriden, CT 06451 | 2006-06-29 |
| 1831683523 | Trisha Kowalski | Physician Assistant | 435 Lewis Ave, Meriden, CT 06451 | 2018-06-18 |
| 1093203424 | Ryan Wessels | Physician Assistant | 435 Lewis Ave, Meriden, CT 06451 | 2018-05-01 |
| 1235599333 | Mcm Dental, LLC | Dentist | 74 Main Street, Lakewood, CT 06451 | 2016-03-02 |
| 1215270533 | Rouzbeh Fateh | Psychiatry & Neurology | 435 Lewis Ave, Meriden, CT 06451 | 2013-04-04 |
| 1790035186 | Jona Lesage Maloney | Music Therapist | 122 Windsor Ave, 2nd Floor, Meriden, CT 06451 | 2012-09-13 |
| Find all providers in zip 06451 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366953457 | Siobhon Andrews | Nurse Practitioner | 39 Oxbow Dr, Meriden, CT 06450-6938 | 2017-10-17 |
| 1710234448 | Aericka Robyn Khongdy | Nurse Practitioner | 816 Broad St, Suite 29, Meriden, CT 06450-4350 | 2012-08-13 |
| 1598066698 | Mark A Gregorio | Nurse Practitioner | 816 Broad St, Meriden, CT 06450-4350 | 2010-11-06 |
| 1760797849 | Loren Fields | Nurse Practitioner | 26 Womens Way, Meriden, CT 06451-3237 | 2010-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750997847 | Rachel Sarmento | Nurse Practitioner | 13 Sanford Dr, Shelton, CT 06484-5507 | 2020-09-23 |
| 1699399618 | Ann Monica Boisvert | Nurse Practitioner | 5 Perryridge Rd Ste 2-248, Greenwich, CT 06830-4608 | 2020-06-05 |
| 1861041121 | Huong T Nguyen | Nurse Practitioner | 400 Capital Blvd Ste 3, Rocky Hill, CT 06067-3576 | 2019-09-10 |
| 1598319980 | Daniella Gould | Nurse Practitioner | 75 Kings Highway Cutoff Ofc, Fairfield, CT 06824-5340 | 2019-07-24 |
| 1770042038 | Linda Lee Meyer | Nurse Practitioner | 320 Lakeview Ave, Waterbury, CT 06705-2145 | 2019-03-17 |
| 1942766761 | Lawrence M Anderson | Nurse Practitioner | 92 Harwood Rd, Waterbury, CT 06706-2420 | 2019-02-17 |
| 1912497751 | Catherine Rice | Nurse Practitioner | 25 Commerce Rd, Newtown, CT 06470-1607 | 2018-05-17 |
| 1407346323 | Irene D Gumboc | Nurse Practitioner | 99 Starr St, Norwich, CT 06360-4025 | 2018-05-16 |
| 1326546839 | Kristin Holly Van Horn | Nurse Practitioner | Winchester Chest Clinic, 789 Howard St, New Haven, CT 06510 | 2018-01-30 |
| 1891207411 | Michelene Wray | Nurse Practitioner | 474 Cowperthwaite St Apt C, Danbury, CT 06811-5518 | 2017-11-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.