Provider Demographics
NPI:1275103665
Name:HOUSTON, KELLY ALYCE (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ALYCE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08518-0207
Mailing Address - Country:US
Mailing Address - Phone:609-937-2773
Mailing Address - Fax:
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:207 (BOX)
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08518-4033
Practice Address - Country:US
Practice Address - Phone:609-937-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01465200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health