Provider Demographics
NPI:1609899608
Name:LYSAGHT, CARMEN B (MSN RNCS APRN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:B
Last Name:LYSAGHT
Suffix:
Gender:F
Credentials:MSN RNCS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD ROAD
Mailing Address - Street 2:ASSOCIATES IN PSYCHOTHERAPY SUITE E204
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4158
Mailing Address - Country:US
Mailing Address - Phone:401-294-9600
Mailing Address - Fax:401-295-7395
Practice Address - Street 1:1130 TEN ROD ROAD
Practice Address - Street 2:ASSOCIATES IN PSYCHOTHERAPY SUITE E204
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4158
Practice Address - Country:US
Practice Address - Phone:401-294-9600
Practice Address - Fax:401-295-7395
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN29243364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46303Medicare UPIN