Provider Demographics
NPI:1962246488
Name:KAJTOR, KATIE LYNN (FNP-BC, NP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:KAJTOR
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 TRAM DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1845
Mailing Address - Country:US
Mailing Address - Phone:203-733-6132
Mailing Address - Fax:
Practice Address - Street 1:50 OLD FIELD POINT RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6157
Practice Address - Country:US
Practice Address - Phone:203-862-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner