Healthcare Provider Details

I. General information

NPI: 1598137663
Provider Name (Legal Business Name): KRISTEN MARIE HAVILAND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ARMISTICE BLVD
PAWTUCKET RI
02860-3242
US

IV. Provider business mailing address

268 RONALD AVE
CUMBERLAND RI
02864-4627
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-4100
  • Fax:
Mailing address:
  • Phone: 774-276-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00747
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: