Individual
AUDREY CMK TIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
132 OLD RIVER RD., SUITE 108, LINCOLN, RI 02865-1397
(401) 723-9250
(814) 339-6165
Mailing address
132 OLD RIVER RD., SUITE 108, LINCOLN, RI 02865-1397
(401) 723-9250
(814) 339-6165
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01729
RI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861244170
—
RI
Enumeration date
04/02/2024
Last updated
10/14/2025
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