Provider Demographics
NPI:1467426619
Name:TITUS, KATHLEEN E (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:TITUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JOHN A. CUMMINGS WAY
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3244
Mailing Address - Country:US
Mailing Address - Phone:401-235-7310
Mailing Address - Fax:401-235-7314
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-235-7310
Practice Address - Fax:401-235-7314
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1068363A00000X
RIPA00948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02237Medicare UPIN
MAAP123101Medicare PIN