=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235049073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOY CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2026
-----------------------------------------------------
Last Update Date | 09/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 ELMWOOD AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-386-4343
-----------------------------------------------------
Fax | 401-386-4355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 ELMWOOD AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-386-4343
-----------------------------------------------------
Fax | 401-386-4355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | MAYELIN PACHECO NUNEZ
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 508-863-6202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------