Healthcare Provider Details

I. General information

NPI: 1225457666
Provider Name (Legal Business Name): RAYNE KENNELLY NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 07/22/2025
Certification Date:
Deactivation Date: 06/10/2025
Reactivation Date: 07/22/2025

III. Provider practice location address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

IV. Provider business mailing address

PO BOX 312
PASCOAG RI
02859-0312
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-9706
  • Fax: 401-295-0920
Mailing address:
  • Phone: 401-567-0800
  • Fax: 401-567-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37862
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: