Healthcare Provider Details

I. General information

NPI: 1588583348
Provider Name (Legal Business Name): KAYLEEN LIANNE MESA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N BROAD ST
ELIZABETH NJ
07208-3302
US

IV. Provider business mailing address

550 N BROAD ST
ELIZABETH NJ
07208-3302
US

V. Phone/Fax

Practice location:
  • Phone: 908-344-9644
  • Fax: 908-344-5000
Mailing address:
  • Phone: 908-344-9644
  • Fax: 908-344-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN45299-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15604400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: