Healthcare Provider Details

I. General information

NPI: 1093243891
Provider Name (Legal Business Name): ANDREA DAVIS PMHNP-BC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 04/24/2024
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 THAYER ST
PROVIDENCE RI
02906-1558
US

IV. Provider business mailing address

118 WARWICK AVE APT 1
CRANSTON RI
02905-3563
US

V. Phone/Fax

Practice location:
  • Phone: 401-401-6487
  • Fax: 401-648-0161
Mailing address:
  • Phone: 401-228-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03752
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN55756
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: