KATHLEEN MARY KELLERMAN PA (Credential# 743163) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KATHLEEN MARY KELLERMAN PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001414. The credential type is physician assistant. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 11 Saxton Lane, Broad Brook, CT 06016. The current status is active.
| Licensee Name | KATHLEEN MARY KELLERMAN PA |
| Credential ID | 743163 |
| Credential Number | 23.001414 |
| Credential Type | Physician Assistant |
| Business Address |
11 Saxton Lane Broad Brook CT 06016 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2003-10-21 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-12-13 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 355006 | CSP.0034312 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2003-11-17 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 873833 | 70.990857 | Emergency Medical Technician | 1999-05-01 | - 2001-09-30 | INACTIVE |
| Street Address | 11 SAXTON LANE |
| City | BROAD BROOK |
| State | CT |
| Zip Code | 06016 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Matthew T Moore | 67 Middle Road, Broad Brook, CT 06016 | Emergency Medical Technician | 2018-08-02 ~ 2020-03-31 |
| Dallas W Hosmer | N24 Mill Pond Drive, Broad Brook, CT 06016 | Heating, Piping & Cooling Limited Journeyperson | 2020-06-23 ~ 2020-08-31 |
| Cathryn E Carroll | 127 East Road, Broad Brook, CT 06016 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Jonathan E Marino · J M Affordable Landscaping | 319 Canyon Ridge Drive, Broad Brook, CT 06016 | Home Improvement Contractor | 2018-09-04 ~ 2019-11-30 |
| Heather Allison Kun | 2 Jessie Ln, Broad Brook, CT 06016 | Registered Nurse | ~ |
| Anna J Mangiafico · Kement | 35 Sullivan Farm Road, Broad Brook, CT 06016 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Melissa V La Belle | 17 C Folkstone Road, Broad Brook, CT 06016 | Notary Public Appointment | 2020-04-01 ~ 2025-03-31 |
| Andrea Kopec | 406 Canyon Ridge Drive, Broad Brook, CT 06016 | Dental Hygienist | 2020-07-01 ~ 2021-06-30 |
| Stephen C Quesnel | 16 Maple Avenue (po Box 349), Broad Brook, CT 06016 | Real Estate Salesperson | 2020-06-15 ~ 2021-05-31 |
| Sophie Carter | 41 Skinner Road, Broad Brook, CT 06016 | Real Estate Salesperson | ~ |
| Find all Licenses in zip 06016 | |||
| City | BROAD BROOK |
| Zip Code | 06016 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + BROAD BROOK |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Joshua Kellerman | 79 Rt 37 W, Toms River, NJ 08755 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Kathleen K Treanor | 111 Jamestown Dr, Springfield, MA 01108-3145 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Kathleen Wilcox | 47 Millard St Fl 2, New Britain, CT 06051-2431 | Physician Assistant | 2020-06-25 ~ 2020-09-30 |
| Kathleen M Shea | 182 Front St., New Haven, CT 06513 | Physician Assistant | 2017-10-01 ~ 2018-09-30 |
| Kathleen M Reccord Pa | 9 1/2 Oakland St, Wilbraham, MA 01095 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Kathleen F Latronica Pa-c | 39 Round Hill Rd, Woodbridge, CT 06525 | Physician Assistant | 2012-07-01 ~ 2013-06-30 |
| Kathleen M Orazietti Pa | 717 Long Hill Ave., Shelton, CT 06484 | Physician Assistant | 2020-01-01 ~ 2020-12-31 |
| Kathleen Hutcheon | 105 Pleasant Ave, White Plains, NY 10605 | Physician Assistant | 1996-08-26 ~ 1997-10-31 |
| Kathleen Kelliher Pa | 111 Whiting Lane, West Hartford, CT 06119 | Physician Assistant | 2019-07-01 ~ 2020-06-30 |
| Rachel Kathleen Valdivieso | 55 Dorset Xing Unit 325, Simsbury, CT 06070-1476 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).