Healthcare Provider Details

I. General information

NPI: 1285407676
Provider Name (Legal Business Name): KEITH L CASTILLOVEITIA APRN ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEITH CHAMBERLAND

II. Dates (important events)

Enumeration Date: 11/06/2023
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 TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN03694
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN03694
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN03694
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: