Healthcare Provider Details

I. General information

NPI: 1740943281
Provider Name (Legal Business Name): CAYLA RICHARDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WARREN AVE STE 302
EAST PROVIDENCE RI
02914-1430
US

IV. Provider business mailing address

900 WARREN AVE STE 302
EAST PROVIDENCE RI
02914-1430
US

V. Phone/Fax

Practice location:
  • Phone: 800-508-4908
  • Fax: 401-228-6236
Mailing address:
  • Phone: 800-508-4908
  • Fax: 401-228-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN50628
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02921
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: