Provider Demographics
NPI:1689954893
Name:JENNINGS MATHIS, KAREN M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:JENNINGS MATHIS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 TOLLGATE RD
Mailing Address - Street 2:PROFESSIONAL REVENUE CYCLE AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:012-730-6414
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:2 DUDLEY ST STE 560
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3230
Practice Address - Country:US
Practice Address - Phone:401-453-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2267972363LP0808X
RIAPRN01971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health