Healthcare Provider Details

I. General information

NPI: 1881746774
Provider Name (Legal Business Name): KELLY CHIRICO APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 KRESSON RD SUITE 104
CHERRY HILL NJ
08034-3200
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-751-7420
  • Fax: 856-424-3113
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN10007600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: