Provider Demographics
NPI:1083986251
Name:WALL, KATHRYN A (APN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:WALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:NEWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 WESCOTT DR.
Mailing Address - Street 2:HBH
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-6654
Mailing Address - Fax:908-788-6452
Practice Address - Street 1:190 RT. 31
Practice Address - Street 2:STE. 100
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-6654
Practice Address - Fax:908-788-6452
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00310900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311081Medicaid
NJ2954298KVMedicare Oscar/Certification