Provider Demographics
NPI:1316497662
Name:HEILMAN, KELLY (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HEILMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 NEW LONDON TPKE STE 101
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2246
Mailing Address - Country:US
Mailing Address - Phone:860-659-8904
Mailing Address - Fax:860-246-5828
Practice Address - Street 1:131 NEW LONDON TPKE STE 101
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2246
Practice Address - Country:US
Practice Address - Phone:860-659-8904
Practice Address - Fax:860-246-5828
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT6379207KA0200X
CT6739363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health