Kinnell-Rust, Holly Roxanne

Kinnell-Rust, Holly Roxanne is an individual health care provider with primary practice located at 320 Pomfret St , Putnam CT 06260-1836. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Kinnell-Rust, Holly Roxanne can be contacted via phone (860) 963-6371.

Contact Information

Primary practice address
320 Pomfret St Putnam CT 06260-1836
Phone: (860) 963-6371
Fax: (860) 963-6413
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 191964 Massachusetts
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2010026851 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 7023 Connecticut

Profile Details

NPI number 1932287893
LBN Legal business name Kinnell-Rust, Holly Roxanne
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Jul 15th, 2019 - about 7 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 1932287893 NPPES
Missouri MEDICAID 1932287893
Missouri Other P00859525
Missouri MEDICAID 008073029
Missouri MEDICAID 184085758
Missouri Other 431560263

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