Manhouly Phouthachack

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

004098 Issued in CT

Practice address

839 Farmington Ave
Bristol, CT 06010-3922

Phone

(866) 389-2727

NPI assigned

Jul 22, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MC Diagnostic of Connecticut, P.C.Group PAC ID 0941382113, 66 clinicians

Minuteclinic Primary Care Connecticut PLLCGroup PAC ID 0244740645, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles (2 of 6)

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

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.

• MC Diagnostic of Connecticut, P.C.

  • Family Nurse Practitioner
  • Rocky Hill, CT
  • NPI 1386821932

  CT, Family

  Medicare reassignment Care Compare group NPD
• Minuteclinic Primary Care Connecticut PLLC

  • Family Nurse Practitioner
  • Rocky Hill, CT
  • NPI 1548076086

  CT, Family

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1295965481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 WASHINGTON AVE",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064731711",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103922",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 2nd Ave S",
            "address_2": "Suite 400",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554023318",
            "country_code": "US",
            "telephone_number": "612-225-1534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHOUTHACHACK",
        "first_name": "MANHOULY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-22",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "004098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Perry Sheridan, PTA
• Lakreshia Perry, LMSW
• Christina Ann Petry
• Leah Pfrommer, RD
• Aiesha Phelmetto, MFT
• Physical Therapy and Massage of CT, LLC
• Physical Therapy Center of Bristol, LLC
• Amanda Sara Piccoli, MSPT
• Rebecca Ann Pierce, LPC
• Donyale M Pina, LCSW

• Family Nurse Practitioner in Bristol, CT
• Providers in Bristol, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.