Healthcare Provider Details

I. General information

NPI: 1346447349
Provider Name (Legal Business Name): KATHLEEN DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE E305
NORTH KINGSTOWN RI
02852-4176
US

IV. Provider business mailing address

120 BIRCHWOOD DR
WAKEFIELD RI
02879-8117
US

V. Phone/Fax

Practice location:
  • Phone: 400-129-4045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN00410
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberPPNS00039
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: