Healthcare Provider Details

I. General information

NPI: 1932020286
Provider Name (Legal Business Name): KIMBERLY PURCELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 LAKE BARNEGAT DR N
FORKED RIVER NJ
08731-1667
US

IV. Provider business mailing address

461 LAKE BARNEGAT DR N
FORKED RIVER NJ
08731-1667
US

V. Phone/Fax

Practice location:
  • Phone: 201-906-1660
  • Fax:
Mailing address:
  • Phone: 201-906-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR15672500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: