Carmen Kokkoros
Individual provider Active NPI Pediatric Nurse Practitioner · Riverside, CT
NPI 1013884832 · NPPES record last updated Oct 17, 2025
Key facts
- NPI
- 1013884832
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 15418 (CT)
- Practice address
- 1171 E Putnam Ave Ste 2B
Riverside, CT 06878-1426 - Phone
- (203) 629-5800
- NPI assigned
- Oct 17, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15418 | CT | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Pediatrics LLP | Past |
Accepting new patients |
Interoperability endpoints
- carmen.kokkoros.1@11000.direct.athenahealth.com
- https://fhir4.healow.com/fhir/r4/BJBJDD/Endpoint/BJBJDD
- https://api.platform.athenahealth.com/11000/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 15418 | CT | Yes |
Addresses
Primary practice location
1171 E Putnam Ave Ste 2B
Riverside, CT 06878-1426
Mailing address
148 Lazy Brook Rd
Monroe, CT 06468-3316
Other providers in Riverside, CT
- Scott Kesselman
- Aigel Khadeeva
- Sohaib Khalid
- Joseph Kim
- Eleonora S Kishelova
- Grete Marie Laine
- Alex E Lash
- Michael Levin
- Life Skills Corp.
- Ross Ryan Maitre I
All providers in Riverside, CT · Pediatric Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.