Provider Demographics
NPI:1457446593
Name:PETITPAS, PATRICIA A (APRN/PCNS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:PETITPAS
Suffix:
Gender:F
Credentials:APRN/PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 METROPOLITAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7922
Mailing Address - Country:US
Mailing Address - Phone:401-738-1820
Mailing Address - Fax:
Practice Address - Street 1:900 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-944-0194
Practice Address - Fax:401-944-0196
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00043101YA0400X, 163WA0400X
RIRN22224163W00000X, 363LP0808X
RIPPNS00064364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000032309OtherRI BLUE CROSS PROVIDER #
RI0000032309OtherRI BC/BS PRVD.#
RI6228710OtherUNITED HEALTH
RI413965OtherRI BLUE CHIP PROVIDER #
RI6228710Medicare PIN
RIQ39680Medicare UPIN
RI0000032309OtherRI BC/BS PRVD.#
RI007057511Medicare ID - Type Unspecified