Provider Demographics
NPI:1053935312
Name:DESPINOS, KATRINA ADORA (CNM, APRN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ADORA
Last Name:DESPINOS
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2917
Mailing Address - Country:US
Mailing Address - Phone:772-607-1085
Mailing Address - Fax:
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-606-3027
Practice Address - Fax:401-455-3547
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
RICNM00188367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty