Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Manhouly Phouthachack

Individual provider Family Nurse Practitioner · NPI 1295965481

Manhouly Phouthachack is a Nurse Practitioner in Bristol, Connecticut. Qualified in 2007, 19 years ago. Practices with Mc Diagnostic of Connecticut, PC, a 65-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
19
Licensed in
CT
In the registry since
2009
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Practice location Address checks out

839 Farmington Ave
Bristol, CT 06010-3922
Phone: (866) 389-2727
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 920 2nd Ave S, Minneapolis, MN 55402-3318 — (612) 225-1534

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 004098 (CT)

Record details

NPI number1295965481
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 22, 2009
Last updated in NPPESMay 16, 2025
Certification dateMay 16, 2025
Mailing address162 Washington Ave, North Haven, CT 06473-1711

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Mc Diagnostic Of Connecticut, P.C. — 65 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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