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General NPI Number Information
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NPI Number | 1275796740
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Entity Type | Individual
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Provider Name | KIRA E PROVOST RN, LCMT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2008
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1145 RESERVOIR AVE SUITE 300
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City | CRANSTON
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State | RI
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Zip | 02920-6055
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Country | US
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Telephone | 401-943-2500
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Fax | 401-942-2227
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Provider Business Mailing Address
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Address Line | 13 WHITMAN ST
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City | SMITHFIELD
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State | RI
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Zip | 02917-3813
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Country | US
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Telephone | 401-486-6951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN26228
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT01762
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License Number State | RI
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