Provider Demographics
NPI:1588088355
Name:CREAGH, KATHRYN
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:CREAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 STILLWATER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-9504
Mailing Address - Country:US
Mailing Address - Phone:203-348-7410
Mailing Address - Fax:203-961-8488
Practice Address - Street 1:29 HOSPITAL PLAZA
Practice Address - Street 2:SUITE 502
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-348-7410
Practice Address - Fax:203-961-8488
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5727363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health