Healthcare Provider Details

I. General information

NPI: 1801056643
Provider Name (Legal Business Name): KRISTIN MELISSA KELLY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

26 BOSKO DR
EAST BRUNSWICK NJ
08816-4542
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax:
Mailing address:
  • Phone: 732-253-3895
  • Fax: 732-253-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number26NJ00153700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00153700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: