Healthcare Provider Details

I. General information

NPI: 1124886858
Provider Name (Legal Business Name): KATHLEEN CUMMINGS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL ST
CAMDEN NJ
08103-1539
US

IV. Provider business mailing address

5026 GARDEN AVE
PENNSAUKEN NJ
08109-1452
US

V. Phone/Fax

Practice location:
  • Phone: 856-583-2400
  • Fax:
Mailing address:
  • Phone: 609-743-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ14912400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: