Provider Demographics
NPI:1427697192
Name:KEARNS, ANNIE D (WHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:D
Last Name:KEARNS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8082
Mailing Address - Country:US
Mailing Address - Phone:860-679-3646
Mailing Address - Fax:860-676-1494
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8085
Practice Address - Country:US
Practice Address - Phone:860-679-3646
Practice Address - Fax:860-679-1494
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH-0000241363LW0102X
CT8661363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health