Healthcare Provider Details

I. General information

NPI: 1669417077
Provider Name (Legal Business Name): JUDITH ASHWORTH PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 COLLEGE HILL RD BLDG 29
WARWICK RI
02886-2776
US

IV. Provider business mailing address

33 COLLEGE HILL RD BLDG 29
WARWICK RI
02886-2776
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-4673
  • Fax: 401-822-4676
Mailing address:
  • Phone: 401-822-4673
  • Fax: 401-822-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN14141
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN00187
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCAPRN00187
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: