Healthcare Provider Details

I. General information

NPI: 1982423901
Provider Name (Legal Business Name): JESSICA LAING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SERVICE AVE BLDG 1
WARWICK RI
02886-1014
US

IV. Provider business mailing address

171 SERVICE AVE BLDG 1
WARWICK RI
02886-1014
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01747
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: