Renee Provost, APRN

Primary specialty

Geropsychiatric Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0813X

License

01998 Issued in CT

Practice address

55 Nye Rd Ste 102
Glastonbury, CT 06033-1281

Phone

(860) 657-3056

Fax

(860) 633-3517

NPI assigned

Oct 22, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Masonicare Behavioral Health, LLC

  • Geriatric Psychiatry Physician
  • Wallingford, CT
  • NPI 1992781488
  NPD (past)
• Masonicare Primary Care Physicians

  • Geriatric Medicine (Internal Medicine) Physician
  • Wallingford, CT
  • NPI 1922084540
  NPD (past)
• The Center for Geriatric and Family Psychiatry, Inc.

  • Mental Health Counselor
  • Glastonbury, CT
  • NPI 1831134766
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1386970598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NYE RD STE 102",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060331281",
            "telephone_number": "860-657-3056",
            "fax_number": "860-633-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 NYE RD STE 102",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060331281",
            "telephone_number": "860-657-3056",
            "fax_number": "860-633-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "RENEE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-22",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0813X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Geropsychiatric",
            "state": "CT",
            "license": "01998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Preskenis, MD
• John T Price, MD
• John Printup, D.D.S.
• Private Counseling Associates LLC
• Prospect Dental
• PS Dental LLC
• Purple Dental LLC
• Purpose Work Counseling Services PLLC
• David Carter Purviance, D.D.S.
• Gabriela Pyzza, CCC-SLP

• Clinical Nurse Specialist in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Clinical Nurse Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.