Provider Demographics
NPI:1487683173
Name:RISHWORTH, CHRISTIE AW (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:AW
Last Name:RISHWORTH
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-6943
Mailing Address - Country:US
Mailing Address - Phone:401-294-0817
Mailing Address - Fax:401-295-0920
Practice Address - Street 1:308 CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7739
Practice Address - Country:US
Practice Address - Phone:401-295-9706
Practice Address - Fax:401-295-0920
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37287363L00000X
RIAPRN01087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINPP37287OtherNURSE PRACTITIONER LICENS
RI9004056Medicaid
RIAPRN01087Medicaid
RIMR1195177OtherDEA LICENSE