Provider Demographics
NPI:1154537728
Name:TIRRELL, KATHLEEN MARIE (CNM)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:TIRRELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:TIRRELL
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:358 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1735
Mailing Address - Country:US
Mailing Address - Phone:401-846-5590
Mailing Address - Fax:
Practice Address - Street 1:358 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1735
Practice Address - Country:US
Practice Address - Phone:401-846-5590
Practice Address - Fax:401-848-7573
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMW00063367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife