Provider Demographics
NPI:1164625646
Name:THYNNE, KELLY (ANP, RNFA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THYNNE
Suffix:
Gender:F
Credentials:ANP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MADISON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-285-7800
Mailing Address - Fax:
Practice Address - Street 1:310 MADISON AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-285-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00116300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical