Healthcare Provider Details

I. General information

NPI: 1073453445
Provider Name (Legal Business Name): OCEAN STATE PRACTITIONERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MONEY HILL RD
CHEPACHET RI
02814-1368
US

IV. Provider business mailing address

15 MONEY HILL RD
CHEPACHET RI
02814-1368
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-5308
  • Fax:
Mailing address:
  • Phone: 401-500-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEITH CASTILLOVEITIA
Title or Position: OWNER
Credential:
Phone: 401-429-9476