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Contact Information

KATHRYN E JACK, APRN
455 LEWIS AVE
SUITE 106
MERIDEN, CT06451-2121
 Phone: 203-886-0036
 Fax: 203-886-0072
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adult Health

363LA2200X 50 Nurse Practitioner
 

Family

363LF0000X 50 Nurse Practitioner
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for KATHRYN E JACK · (Female)

NPI Number 1265456347
Status Active
Credentials APRN (Advanced Practice Registered Nurse)
Entity Individual
Enumeration date 07/26/2006
Last updated 11/05/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • CT License # 002455
  • CT Medicaid 004219491
Hospital affiliation(s)
  • MIDSTATE MEDICAL CENTER - (Acute Care)
    435 LEWIS AVE
    MERIDEN, CT 06450
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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