Healthcare Provider Details

I. General information

NPI: 1376970467
Provider Name (Legal Business Name): KATHRYN L KUMTA APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MONMOUTH RD
OAKHURST NJ
07755-1654
US

IV. Provider business mailing address

6 DEER POND LN
HOLMDEL NJ
07733-1253
US

V. Phone/Fax

Practice location:
  • Phone: 173-222-3243
  • Fax:
Mailing address:
  • Phone: 732-533-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00464000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: