Kathryn A Proulx, CNP, PH.D.

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

001162 Issued in CT

Practice address

1049 Main St
Springfield, MA 01103-2114

Phone

(413) 739-1100

Fax

(413) 304-4666

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481846400000",
    "number": "1376621615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 MAIN ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011032114",
            "telephone_number": "413-739-1100",
            "fax_number": "413-304-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 MAIN ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011032114",
            "telephone_number": "413-739-1100",
            "fax_number": "413-304-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROULX",
        "first_name": "KATHRYN",
        "middle_name": "A",
        "credential": "CNP, PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2016-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "127180",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "001162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110028120",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalya Prokhorova, M.D.
• Candace Nichole Pronovost
• Tracy Pronovost
• Latoya Chermaine Prophet
• Jared Proulx
• Shellane Prout, DPT
• Taryn Prout
• Kirsten Lee Prouty, MA, CCC-SLP
• Raeanne Provencher
• Christina Gail Provenza, MD

• Psychiatric/Mental Health Nurse Practitioner in Springfield, MA
• Providers in Springfield, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.