Individual
KEVIN DJATCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
112573-21
NH
367500000X
Certified Registered Nurse Anesthetist
112573-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN04818
RI
Other
Enumeration date
07/02/2024
Last updated
01/05/2026
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