Healthcare Provider Details

I. General information

NPI: 1063818359
Provider Name (Legal Business Name): KATHARINE BIRD WHITE PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 OAKLAWN AVE
CRANSTON RI
02920-3822
US

IV. Provider business mailing address

247 OAKLAWN AVE
CRANSTON RI
02920-3822
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-8775
  • Fax: 401-615-8776
Mailing address:
  • Phone: 401-615-8775
  • Fax: 401-615-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN18763
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN00003
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN18763
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN00003
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: