Provider Demographics
NPI:1952942310
Name:ROCKWELL, JEREMY TYLER (DNP)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:TYLER
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1168
Mailing Address - Country:US
Mailing Address - Phone:401-335-5708
Mailing Address - Fax:401-213-3274
Practice Address - Street 1:120 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1168
Practice Address - Country:US
Practice Address - Phone:401-335-5708
Practice Address - Fax:401-213-3274
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8532363LP0808X, 363LP0808X, 363LP0808X
RIAPRN03667363LP0808X, 363LP0808X
CT165179163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health