Healthcare Provider Details

I. General information

NPI: 1659235554
Provider Name (Legal Business Name): KERRI CALLAHAN RN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N MAIN ST UNIT 4
PROVIDENCE RI
02904-5770
US

IV. Provider business mailing address

6 LAUREL LN
WEST WARWICK RI
02893-2329
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN74093
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: