Provider Demographics
NPI:1215562566
Name:THAYER, KATIE (APRN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:300 CENTERVILLE RD STE 101W
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0201
Mailing Address - Country:US
Mailing Address - Phone:401-732-4500
Mailing Address - Fax:
Practice Address - Street 1:300 CENTERVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0200
Practice Address - Country:US
Practice Address - Phone:401-732-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health