Healthcare Provider Details

I. General information

NPI: 1700972528
Provider Name (Legal Business Name): JENNY LYN HEALEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD CNEMG SURGICAL CARE
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-6611
  • Fax: 401-921-6952
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00681
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: