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General NPI Number Information
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NPI Number | 1902546203
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Entity Type | Individual
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Provider Name | DERRIC JAMES VIGEANT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 825 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4728
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Country | US
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Telephone | 401-456-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 646 GREENVILLE AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-1331
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Country | US
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Telephone | 401-426-9887
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | PA1450
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | PA01450
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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