Provider Demographics
NPI:1427158781
Name:CASAGNI, KIMBERELY SUE (APRN-FNP)
Entity type:Individual
Prefix:
First Name:KIMBERELY
Middle Name:SUE
Last Name:CASAGNI
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-578-4630
Practice Address - Fax:203-578-4629
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003065363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003065CT03OtherANTHEM
CT030650OtherCONNETICARE
CT2V6388OtherHEALTHNET
CTP3387910OtherOXFORD
CTP00277966OtherRAILROAD MEDICARE
CT004257459Medicaid
CT400003065CT05OtherANTHEM
CT004257459Medicaid
CT400003065CT05OtherANTHEM