Healthcare Provider Details

I. General information

NPI: 1255318341
Provider Name (Legal Business Name): JOANNE M MCKENNA APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE M NERI APRN BC

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E MAIN RD
MIDDLETOWN RI
02842-4988
US

IV. Provider business mailing address

58 OLD STONE CHURCH RD
LITTLE COMPTON RI
02837-1071
US

V. Phone/Fax

Practice location:
  • Phone: 401-608-3322
  • Fax: 401-608-3323
Mailing address:
  • Phone: 401-608-3322
  • Fax: 401-608-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number185839
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17379
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: