Healthcare Provider Details

I. General information

NPI: 1235284431
Provider Name (Legal Business Name): CHERYL HAYNES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 POST RD SUITE 103
WARWICK RI
02886-3003
US

IV. Provider business mailing address

4 ARCHER WAY
COVENTRY RI
02816-4665
US

V. Phone/Fax

Practice location:
  • Phone: 401-384-6007
  • Fax: 401-773-7878
Mailing address:
  • Phone: 401-241-3324
  • Fax: 401-773-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP37125
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37125
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN32050
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: