Provider Demographics
NPI:1568282952
Name:MANAHAN, KELSEY LYNN (NP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:465 SOUTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6442
Mailing Address - Country:US
Mailing Address - Phone:973-971-5227
Mailing Address - Fax:
Practice Address - Street 1:435 SOUTH ST STE 250
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6477
Practice Address - Country:US
Practice Address - Phone:973-971-5227
Practice Address - Fax:973-290-7164
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15168300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics