Healthcare Provider Details

I. General information

NPI: 1265170492
Provider Name (Legal Business Name): JORDAN E BYRNES I R-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLEASANT VIEW AVE
GREENVILLE RI
02828-1905
US

IV. Provider business mailing address

5 PLEASANT VIEW AVE
GREENVILLE RI
02828-1905
US

V. Phone/Fax

Practice location:
  • Phone: 401-600-1231
  • Fax:
Mailing address:
  • Phone: 401-600-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03400
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: