Individual provider Active NPI

Kaitlin Ann Moran, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Danbury, CT
National Provider Identifier
1174379200
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
13831 Issued in CT
Practice address
24 Hospital Ave
Danbury, CT 06810-6077
Phone
(203) 739-7000
NPI assigned
Apr 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Acute Care Nurse Practitioner 363LA2100X 13831 CT Primary
Emergency Registered Nurse 163WE0003X 100498 CT

Addresses

Primary practice location

24 Hospital Ave
Danbury, CT 06810-6077

Mailing address

135 Walnut St
Stratford, CT 06615-7545

Other practice location 1

135 Walnut St
Stratford, CT 06615-7545
Phone (203) 414-7572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119003026 CT Practitioner - Nurse Practitioner 1456886035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

111 Osborne St
Suite 121
Danbury, CT 06810-6019
Phone (203) 739-7038

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
13831CTMDGeneral Practice Dentistry
100498CTMDEmergency Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Nuvance Health Medical Practice CT, Inc. CurrentSince Dec 23, 2024 Accepting new patients

Locations

111 Osborne St
Danbury, CT 06810
Phone (203) 739-7131

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

111 Osborne St
Ste 121
Danbury, CT 06810
Phone (203) 739-7010

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1174379200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 WALNUT ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066157545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 HOSPITAL AVE",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106077",
            "telephone_number": "203-739-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Walnut St",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "CT",
            "postal_code": "066157545",
            "country_code": "US",
            "telephone_number": "203-414-7572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "KAITLIN",
        "middle_name": "ANN",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CT",
            "license": "13831",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CT",
            "license": "100498",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danbury, CT

Sources for this page

Verify at the official NPI Registry.