=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255267043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN RX CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2026
-----------------------------------------------------
Last Update Date | 06/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 CRESTVIEW DR
-----------------------------------------------------
City | WESTERLY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02891-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-295-7855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 287 W SPRING ST
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-295-7855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | KRIPA PLAPETTA DAMODHARAN
-----------------------------------------------------
Credential | DNP, FNP
-----------------------------------------------------
Telephone | 203-285-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------