Kelly Theresa Tobin

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

009549 Issued in CT

Practice address

153 Hazard Ave
Enfield, CT 06082-4592

Phone

(860) 253-5020

NPI assigned

Sep 13, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1164072062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WATERSIDE XING STE 401",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951587",
            "telephone_number": "860-697-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 HAZARD AVE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824592",
            "telephone_number": "860-253-5020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 Madsen Rd",
            "address_purpose": "LOCATION",
            "city": "West Hartford",
            "state": "CT",
            "postal_code": "061102504",
            "country_code": "US",
            "telephone_number": "860-305-3225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1491 Main St",
            "address_purpose": "LOCATION",
            "city": "Willimantic",
            "state": "CT",
            "postal_code": "062261914",
            "country_code": "US",
            "telephone_number": "860-456-3215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOBIN",
        "first_name": "KELLY",
        "middle_name": "THERESA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-13",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "084503",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "009549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Thompson
• Jaykumar Ranchodbhai Thumar, MD, MBBS
• Lori M Tilden-Smith, PA
• Casie Timmons
• John A Tinnirella
• Dale T Toce, MD
• Madison E Tonkin
• Tony Hill DMD Inc
• Angelys Torres
• Barbara Tortora-Grochowski, PT

• Psychiatric/Mental Health Nurse Practitioner in Enfield, CT
• Providers in Enfield, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.