Healthcare Provider Details

I. General information

NPI: 1821670407
Provider Name (Legal Business Name): JILL ANN MCKENNA BAILEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 09/15/2022
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY STE 7A
EAST PROVIDENCE RI
02914-5315
US

IV. Provider business mailing address

450 VETERANS MEMORIAL PKWY STE 7A
EAST PROVIDENCE RI
02914-5315
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5335
  • Fax:
Mailing address:
  • Phone: 203-880-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN02562
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN02562
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02562
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: