Healthcare Provider Details

I. General information

NPI: 1740055821
Provider Name (Legal Business Name): KESHA PHILLIPS MSN, APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 NJ-31 STE 100A
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

190 NJ 31 STE 100A
FLEMINGTON NJ
08822
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6654
  • Fax:
Mailing address:
  • Phone: 908-788-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP028691
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14945100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: