Individual
KRISTEN U. STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-8016
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-8016
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1490
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001490
CT LICENSE #
CT
Enumeration date
02/21/2006
Last updated
03/01/2012
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