Provider Demographics
NPI:1588274096
Name:HOUDE, KAITLYN MARGARET (APRN)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARGARET
Last Name:HOUDE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARGARET
Other - Last Name:KIESLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 MAURO DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-2415
Mailing Address - Country:US
Mailing Address - Phone:203-499-7484
Mailing Address - Fax:913-440-4623
Practice Address - Street 1:43 HALL AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6516
Practice Address - Country:US
Practice Address - Phone:203-499-7484
Practice Address - Fax:913-440-4623
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health