Healthcare Provider Details

I. General information

NPI: 1982011698
Provider Name (Legal Business Name): KRISTEN ELIZABETH KANE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ELIZABETH WARD PA

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 TIOGUE AVE
COVENTRY RI
02816-6116
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-6800
  • Fax:
Mailing address:
  • Phone: 151-276-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00766
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3642-23
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3642
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6126
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: