MEDICARE: JAMES W JEWETT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN64824	RI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN03893	RI

General Provider Information

NPI Number	:	1710688577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W JEWETT RN

Provider Business Mailing Address
First Line	:	175 NATE WHIPPLE HWY STE 202
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1423
Country	:	US
Telephone Number	:	617-767-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 NATE WHIPPLE HWY STE 202
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1423
Country	:	US
Telephone Number	:	617-767-7878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	12/01/2025

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