Healthcare Provider Details

I. General information

NPI: 1780130989
Provider Name (Legal Business Name): KELLY KERRIGAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 US ROUTE 130
CINNAMINSON NJ
08077
US

IV. Provider business mailing address

101 US ROUTE 130
CINNAMINSON NJ
08077
US

V. Phone/Fax

Practice location:
  • Phone: 609-933-7044
  • Fax:
Mailing address:
  • Phone: 609-933-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00630300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: