NPI 1639843303 · live from the CMS NPI Registry
Koann Therapeutic Services INC
Nurse Practitioner, Psych/Mental Health in Providence, RI. National Provider Identifier 1639843303, active.
NPI record
| NPI | 1639843303 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Psych/Mental Health 363LP0808X |
| Practice location | 845 N Main St, Providence, RI 02904 |
| Practice phone | 401-648-7172 |
| Mailing address | Po Box 3085, Pawtucket, RI 02861 |
| Enumerated | August 5, 2021 |
| Last updated | January 12, 2026 |
| Authorized official | Akos Antwi, Provider/Ceo |
| Other names | Revive Therapeutic Services |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center, Multi-Specialty | 261QM1300X | — |
| Registered Nurse, Psych/Mental Health, Child & Adolescent | 163WP0807X | — |
| Clinic/Center, Mental Health (Including Community Mental Health Center) | 261QM0801X | — |
| Registered Nurse | 163W00000X | — |
| Case Management | 251B00000X | — |
| Registered Nurse, Psych/Mental Health, Adult | 163WP0809X | — |
| Nurse Practitioner, Psych/Mental Health primary | 363LP0808X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.