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General NPI Number Information
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NPI Number | 1700506565
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Entity Type | Individual
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Provider Name | TRICIA KELLUM NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 100 COMMERCE DR STE 300
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City | NEWARK
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State | DE
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Zip | 19713-2878
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Country | US
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Telephone | 302-726-1081
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Fax |
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Provider Business Mailing Address
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Address Line | 100 COMMERCE DR STE 300
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City | NEWARK
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State | DE
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Zip | 19713-2878
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Country | US
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Telephone | 302-726-1081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 29862
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 287482
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | L8-0010769
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 287482
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License Number State | GA
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