Healthcare Provider Details

I. General information

NPI: 1235496308
Provider Name (Legal Business Name): KIMKYLA KRITCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 HWY 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1945 HWY 33
NEPTUNE NJ
07753-4859
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-2325
  • Fax:
Mailing address:
  • Phone: 732-776-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number26NR13117700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00787400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: