Healthcare Provider Details

I. General information

NPI: 1215562566
Provider Name (Legal Business Name): KATIE THAYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE ELIZABETH HAMMOND APRN

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE RD STE 101
WARWICK RI
02886-0200
US

IV. Provider business mailing address

300 CENTERVILLE RD STE 101W
WARWICK RI
02886-0201
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-4500
  • Fax:
Mailing address:
  • Phone: 401-732-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02456
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: