Provider Demographics
NPI:1184656399
Name:LLOYD, KATHLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-2631
Practice Address - Country:US
Practice Address - Phone:732-643-2070
Practice Address - Fax:732-643-2015
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05956100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7244304Medicaid
522114204COtherBCBS OF NJ
04-09467OtherEVERCARE
522114204COtherBCBS OF NJ
P00171221Medicare PIN
NJ7244304Medicaid
S38877Medicare UPIN
04-09467OtherEVERCARE