Provider Demographics
NPI:1427332188
Name:MORGAN, KIMBERLY GARRUTO (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GARRUTO
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GARRUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7 WAHACKME LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-3928
Mailing Address - Country:US
Mailing Address - Phone:646-765-8820
Mailing Address - Fax:
Practice Address - Street 1:45 PINE ST STE 6A
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5428
Practice Address - Country:US
Practice Address - Phone:203-399-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305662-1363LA2200X
NYF401363-1363LP0808X
CT10995363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health