Fothergill, Keva C

Fothergill, Keva C is an individual health care provider with primary practice located at 26 Lafayette St , Norwich CT 06360-3408. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Fothergill, Keva C can be contacted via phone (860) 889-7321.

Contact Information

Primary practice address
26 Lafayette St Norwich CT 06360-3408
Phone: (860) 889-7321
Fax: (860) 444-7401
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 000909 Connecticut

Profile Details

NPI number 1285793935
LBN Legal business name Fothergill, Keva C
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 8th, 2006
Last updated Sep 4th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285793935 NPPES
Connecticut MEDICAID 1285793935

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