Basic Information
| Provider Information | |||||||||
| NPI: | 1891755518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORMAN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061101646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962200 | ||||||||
| FaxNumber: | 8605617272 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061101646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962200 | ||||||||
| FaxNumber: | 8605617272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 12/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000457 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 000457 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1891755518 | 01 | CT | NPI | OTHER |