Provider Demographics
NPI:1114573110
Name:HICKS, KELLI ELIZABETH (DNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ELIZABETH
Other - Last Name:MCLOUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 S COUNTY TRL STE 301
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5083
Mailing Address - Country:US
Mailing Address - Phone:401-398-0860
Mailing Address - Fax:401-398-0861
Practice Address - Street 1:1351 S COUNTY TRL STE 301
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5083
Practice Address - Country:US
Practice Address - Phone:401-398-0860
Practice Address - Fax:401-398-0861
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN66560163W00000X
MARN2267675363L00000X, 363LF0000X
RICAPRN02386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner