Provider Demographics
NPI:1790876670
Name:ROY, KATHERINE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:ROY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7694
Mailing Address - Country:US
Mailing Address - Phone:401-206-6825
Mailing Address - Fax:
Practice Address - Street 1:300 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4222
Practice Address - Country:US
Practice Address - Phone:401-430-2000
Practice Address - Fax:401-277-3682
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN29485163W00000X, 163WC0400X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKA51371Medicaid