Healthcare Provider Details

I. General information

NPI: 1770244774
Provider Name (Legal Business Name): A PEDIATRIC EVOLUTION, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE STE 202
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

1526 ATWOOD AVE STE 202
JOHNSTON RI
02919-3289
US

V. Phone/Fax

Practice location:
  • Phone: 401-642-8080
  • Fax: 401-246-8230
Mailing address:
  • Phone: 401-642-8080
  • Fax: 401-246-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY TILLINGHAST
Title or Position: OWNER/OTR/L
Credential: MS, OTR/L
Phone: 401-369-6366