Healthcare Provider Details

I. General information

NPI: 1538934682
Provider Name (Legal Business Name): KEIANDRA V VINSON DNP, MBA,PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEIANDRA V BLUDSAW DNP, MBA, PMHNP

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2243
US

IV. Provider business mailing address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2243
US

V. Phone/Fax

Practice location:
  • Phone: 732-605-6364
  • Fax:
Mailing address:
  • Phone: 732-605-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15603400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NR23811500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: