Healthcare Provider Details

I. General information

NPI: 1629473590
Provider Name (Legal Business Name): ALYSSA KORTSCHINSKY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE RD
WARWICK RI
02886-0200
US

IV. Provider business mailing address

300 CENTERVILLE RD
WARWICK RI
02886-0200
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-4500
  • Fax:
Mailing address:
  • Phone: 401-732-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN53371
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03831
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: