Provider Demographics
NPI:1992092142
Name:LE BEAU, KRISTIN A (APN)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:A
Last Name:LE BEAU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:STROBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:181 W WHITE HORSE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-3234
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00338500363LP0808X
NJ26NR11417700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification