Individual
LARA BETH KOKENOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
425 POST RD FL 2, FAIRFIELD, CT 06824-6232
(203) 254-1576
Mailing address
455 HOPE ST APT 3G, STAMFORD, CT 06906-1330
(203) 257-1829
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002163
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002163
PA LICENSE
CT
Enumeration date
10/22/2008
Last updated
03/07/2023
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