Healthcare Provider Details

I. General information

NPI: 1871006056
Provider Name (Legal Business Name): CAROLINE CLAIRE KINNEY RN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

121 KING ST
WARWICK RI
02886-1257
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2850
  • Fax:
Mailing address:
  • Phone: 401-339-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number01746
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN35015
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: