Healthcare Provider Details

I. General information

NPI: 1174455042
Provider Name (Legal Business Name): SHANNON KATHLEEN LEVESQUE MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEEHAN LN
CUMBERLAND RI
02864-1413
US

IV. Provider business mailing address

195 FAIRFIELD DR
NORTH KINGSTOWN RI
02852-1953
US

V. Phone/Fax

Practice location:
  • Phone: 401-658-2525
  • Fax:
Mailing address:
  • Phone: 508-846-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: