Basic Information
| Provider Information | |||||||||
| NPI: | 1952054496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERVASINI | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 S COUNTY COMMONS WAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | SOUTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028798270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017830084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 59 S COUNTY COMMONS WAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | SOUTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028798270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017830084 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2022 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN02966 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.