Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 6379 | CT |
N | 363LA2200X | Nurse Practitioner - Adult Health | 6739 | CT |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 6739 | CT |
NPI | 1316497662 |
---|---|
Provider Name | Kelly Heilman |
First Address | Glastonbury, CT 06033-2246 |
Second Address | Glastonbury, CT 06033-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 09/12/2021 |