Healthcare Provider Details

I. General information

NPI: 1801157151
Provider Name (Legal Business Name): KACIA ANNE YAZBAK TOUSSAINT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WELLS ST
WESTERLY RI
02891-2934
US

IV. Provider business mailing address

25 WELLS ST
WESTERLY RI
02891-2934
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-3325
  • Fax:
Mailing address:
  • Phone: 401-348-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00641
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7630
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: