Healthcare Provider Details

I. General information

NPI: 1497200018
Provider Name (Legal Business Name): KIMBERLY MONESTIME PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MADISON AVE
MADISON NJ
07940-1006
US

IV. Provider business mailing address

285 MADISON AVE
MADISON NJ
07940-1006
US

V. Phone/Fax

Practice location:
  • Phone: 973-443-8535
  • Fax: 973-443-8174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2310614
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61526102
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013035
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00988100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: