Basic Information
| Provider Information | |||||||||
| NPI: | 1235496308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRITCH | ||||||||
| FirstName: | KIMKYLA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 HWY 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1945 HWY 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 12/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | 26NR13117700 | NJ | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 363LP0808X | 26NJ00787400 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.