Provider Demographics
NPI:1255318341
Name:MCKENNA, JOANNE M (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:M
Other - Last Name:NERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN BC
Mailing Address - Street 1:58 OLD STONE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE COMPTON
Mailing Address - State:RI
Mailing Address - Zip Code:02837-1071
Mailing Address - Country:US
Mailing Address - Phone:401-608-3322
Mailing Address - Fax:401-608-3323
Practice Address - Street 1:58 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4988
Practice Address - Country:US
Practice Address - Phone:401-608-3322
Practice Address - Fax:401-608-3323
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185839363LA2200X
RI17379363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASAM 598451Medicare UPIN