Provider Demographics
NPI:1134938129
Name:LY, ROKHAYA (BSN MSN AGNP)
Entity type:Individual
Prefix:
First Name:ROKHAYA
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:BSN MSN AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2631
Mailing Address - Country:US
Mailing Address - Phone:401-579-3471
Mailing Address - Fax:
Practice Address - Street 1:8 HIAWATHA TRL
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-3320
Practice Address - Country:US
Practice Address - Phone:603-512-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310857363L00000X
RIAPRN04387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner