James Mark Badger, PHD

Individual provider Active NPI Adult Health Nurse Practitioner · Providence, RI

NPI 1710169792 · NPPES record last updated Mar 25, 2020

Key facts

NPI
1710169792
Entity type
Individual (NPI type 1)
Primary specialty
Adult Health Nurse Practitioner 363LA2200X
License
APRN00898 (RI)
Practice address
593 Eddy St
Apc 948
Providence, RI 02903-4923
Phone
(401) 444-5480
Fax
(401) 444-3492
NPI assigned
Nov 30, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PNS00001RIMDAdult Psychiatric/Mental Health Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X PNS00001 RI
Adult Health Nurse Practitioner 363LA2200X APRN00898 RI Yes

Addresses

Primary practice location

593 Eddy St
Apc 948
Providence, RI 02903-4923

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (401) 444-6779

Other providers in Providence, RI

All providers in Providence, RI · Adult Health Nurse Practitioner in Rhode Island

Sources for this page

Verify at the official NPI Registry.