Provider Demographics
NPI:1447292099
Name:HAUGHTON, KATHLEEN A (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291943
Mailing Address - Street 2:525 ROYAL PARKWAY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1914
Mailing Address - Country:US
Mailing Address - Phone:833-953-0829
Mailing Address - Fax:615-237-1434
Practice Address - Street 1:80 CONGRESS STREET
Practice Address - Street 2:SAVIDA HEALTH, PC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-0110
Practice Address - Country:US
Practice Address - Phone:413-732-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0382311Medicaid
MANP0649OtherBLUE CROSS BLUE SHIELD
MA188094OtherCONNECTICARE, INC. OF MA
MANP0649Medicare ID - Type Unspecified
MANP0649OtherBLUE CROSS BLUE SHIELD