Provider Demographics
NPI:1538172218
Name:D'AGOSTINO, KYM E (APRN)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:E
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TURKEY HILL RD S STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5525
Mailing Address - Country:US
Mailing Address - Phone:203-464-9377
Mailing Address - Fax:203-341-0260
Practice Address - Street 1:1 TURKEY HILL RD S STE 100
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5525
Practice Address - Country:US
Practice Address - Phone:203-464-9377
Practice Address - Fax:203-341-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002931208000000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043767Medicaid