Healthcare Provider Details

I. General information

NPI: 1689201980
Provider Name (Legal Business Name): KATHERINE ELIZABETH MOYNIHAN APRN, FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE BLISS

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 BROADWAY STE 102
PROVIDENCE RI
02909-1101
US

IV. Provider business mailing address

94 OVERLOOK DR
EAST GREENWICH RI
02818-4721
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-0392
  • Fax: 774-209-4469
Mailing address:
  • Phone: 401-206-0392
  • Fax: 774-209-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02304
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04737
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: