MEDICARE: KEYSHANNA APPLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15026100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588415210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYSHANNA APPLE

Provider Business Mailing Address
First Line	:	195 MAPLEWOOD AVE STE 1
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 MAPLEWOOD AVE STE 1
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2700
Country	:	US
Telephone Number	:	862-368-2319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	06/05/2026

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Directions to “ KEYSHANNA APPLE ” Practice Location

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