Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kathleen Reilly

Individual provider Mental Health Counselor · NPI 1417659962

Kathleen Reilly is a Nurse Practitioner in Providence, Rhode Island. Qualified in 2023, 3 years ago. Practices with Lifespan Physician Group Inc, a 1,125-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Rhode Island.

Years since qualifying
3
Licensed in
RI
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

194 Waterman St
Providence, RI 02906-4015
Phone: (401) 633-2929
Fax: (888) 602-6957
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence APRN03630 (RI)
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1417659962
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 20, 2023
Last updated in NPPESDecember 27, 2023
Certification dateDecember 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Lifespan Physician Group Inc — 1125 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Providence