Individual
MS. KIRA E PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LCMT
Contact information
Practice address
1145 RESERVOIR AVE, SUITE 300, CRANSTON, RI 02920-6055
(401) 943-2500
(401) 942-2227
Mailing address
13 WHITMAN ST, SMITHFIELD, RI 02917-3813
(401) 486-6951
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN26228
RI
225700000X
Massage Therapist
MT01762
RI
Other
Enumeration date
07/05/2008
Last updated
06/23/2010
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