Provider Demographics
NPI:1770632523
Name:PARKER, KATHLEEN (RNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TOLL GATE RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4447
Mailing Address - Country:US
Mailing Address - Phone:401-921-5855
Mailing Address - Fax:401-921-6863
Practice Address - Street 1:176 TOLL GATE RD STE 103
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4479
Practice Address - Country:US
Practice Address - Phone:401-921-5855
Practice Address - Fax:401-921-6863
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner