Healthcare Provider Details

I. General information

NPI: 1124966635
Provider Name (Legal Business Name): MS. HEIDI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

IV. Provider business mailing address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

V. Phone/Fax

Practice location:
  • Phone: 401-562-1020
  • Fax:
Mailing address:
  • Phone: 401-562-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN04809
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: