Provider Demographics
NPI:1093092488
Name:HERLIHY RAND, KIMBERLY A (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HERLIHY RAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 HIGHWAY 138 STE 122
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9694
Mailing Address - Country:US
Mailing Address - Phone:732-280-1200
Mailing Address - Fax:732-280-1207
Practice Address - Street 1:3350 HIGHWAY 138 STE 122
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9694
Practice Address - Country:US
Practice Address - Phone:732-280-1200
Practice Address - Fax:732-280-1207
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00344300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily