Healthcare Provider Details

I. General information

NPI: 1770614703
Provider Name (Legal Business Name): JOANNE KENYON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CHERRY LN
WAKEFIELD RI
02879-3617
US

IV. Provider business mailing address

PO BOX 899
CHARLESTOWN RI
02813-0899
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-1367
  • Fax: 401-789-6744
Mailing address:
  • Phone: 401-789-1367
  • Fax: 401-364-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN32847
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: