Provider Demographics
NPI:1528802220
Name:PEREZ, KELLY ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MARY LN
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1009
Mailing Address - Country:US
Mailing Address - Phone:908-472-5871
Mailing Address - Fax:
Practice Address - Street 1:26 MARY LN
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1009
Practice Address - Country:US
Practice Address - Phone:908-472-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11463600163W00000X
NJ26NJ15092100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse