KATHLEEN FAVA (NPI# 1053682765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053682765 |
| Entity Type | Individual |
| Full Name | KATHLEEN FAVA |
| Credential | ACNP-BC |
| Practice Address |
593 Eddy Street, Jane Brown, 2 South Providence RI 02903-4923 |
| Mailing Address |
117 Ellenfield St Ste 101 Providence RI 02905-4513 |
| Practice Telephone | 4014445943 |
| Practice Fax Number | 4014444216 |
| Mailing Telephone | 4014446779 |
| Mailing Fax Number | 4014446912 |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2018-12-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN34380 | RI | Nursing Service Providers |
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
NPP37680 | RI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 455 Toll Gate Rd, Warwick, RI 028862759 | 4017377000 | |
| 593 Eddy St, Providence, RI 029034923 | 4014445943 | 4014444216 |
| Street Address |
593 EDDY STREET, JANE BROWN, 2 SOUTH |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02903-4923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285083295 | Brittany Fraser | Physician Assistant | 593 Eddy Street, Jane Brown, 2 South, Providence, RI 02903-4923 | 2016-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475755 | Sarah Fellows | Student in an Organized Health Care Education/Training Program | 350 Eddy Street, Uri Nursing Education Center, Providence, RI 02903 | 2020-10-20 |
| 1093328262 | Esther Robbins | Social Worker | 290 West Exchange St., Suite 100, Providence, RI 02903 | 2020-08-27 |
| 1720619489 | Ivy Marie Mcdonald | Behavioral Analyst | 290 W Exchange St #101, Providence, RI 02903 | 2020-01-31 |
| 1447802707 | Natalie Monaghan, LLC | Social Worker | 545 South Water Street, Providence, RI 02903 | 2019-07-16 |
| 1760049522 | Daniel Steven Alanko | Pediatrics | 293 Eddy Street, Providence, RI 02903 | 2019-05-28 |
| 1154894368 | Margaret Emily Dyson | Behavior Technician | 290 W. Exchange St, Providence, RI 02903 | 2019-01-10 |
| 1497235014 | Yao Zhou Liu | Surgery | 593 Eddy St - Rhode Island Hospital, Providence, RI 02903 | 2018-08-14 |
| 1558840645 | Tamara Gore | Behavior Technician | 290 W Exchange Street Suite 101, Providence, RI 02903 | 2018-08-09 |
| 1437642709 | Adrian Cotarelo | Student in an Organized Health Care Education/Training Program | 174 Wickenden St, Apt. 3rd Floor, Providence, RI 02903 | 2018-06-12 |
| 1356833024 | Natalie Rita Noonan | Clinical Neuropsychologist | 593 Eddy St Ste 430, Providence, RI 02903 | 2018-05-30 |
| Find all providers in zip 02903 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699339721 | Melissa Cardona | Nurse Practitioner | 164 Summit Ave Fl 2, Providence, RI 02906-2853 | 2019-04-24 |
| 1811499668 | Allison Rosener Ford | Nurse Practitioner | Neuro-critical Care, 593 Eddy Street, Providence, RI 02903-4923 | 2018-03-07 |
| 1134657505 | Emily Daniell | Nurse Practitioner | 830 Chalkstone Ave Fl 3e, Providence, RI 02908-4734 | 2017-05-31 |
| 1477098069 | Beth Perry | Nurse Practitioner | 830 Chalstone Ave., Providence, RI 02908 | 2017-01-05 |
| 1477931913 | Linda Otway Colvin | Nurse Practitioner | 16 Woodland Ter, Providence, RI 02906-5807 | 2015-05-17 |
| 1184031973 | Anne Goldstein Silbert | Nurse Practitioner | 2 Dudley St Ste 360, Providence, RI 02905-3248 | 2014-07-14 |
| 1780299594 | Bonnie Ann Blaney | Nurse Practitioner | 235 Plain St, Providence, RI 02905-3240 | 2020-09-09 |
| 1083255509 | Beth Dufour | Nurse Practitioner | 593 Eddy St, Providence, RI 02903-4923 | 2019-10-06 |
| 1831743095 | Tracy Lynn Carraggi | Nurse Practitioner | 164 Summit Ave, Providence, RI 02906-2853 | 2019-07-26 |
| 1780248922 | Audrey Ross | Nurse Practitioner | 593 Eddy St, Providence, RI 02903-4923 | 2019-04-23 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02903 |
Please comment or provide details below to improve the information on KATHLEEN FAVA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.