Healthcare Provider Details

I. General information

NPI: 1710823018
Provider Name (Legal Business Name): MADISEN KEARNEY KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

33 STANIFORD ST FL 1
PROVIDENCE RI
02905-3100
US

IV. Provider business mailing address

33 STANIFORD ST FL 1
PROVIDENCE RI
02905-3100
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-8800
  • Fax:
Mailing address:
  • Phone: 401-421-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN05173
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: