Provider Demographics
NPI:1316185259
Name:WALKER, KELLY ELISABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELISABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ELISABETH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1395 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2760
Mailing Address - Country:US
Mailing Address - Phone:856-282-2050
Mailing Address - Fax:856-352-6713
Practice Address - Street 1:1395 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2760
Practice Address - Country:US
Practice Address - Phone:856-282-2050
Practice Address - Fax:856-352-6713
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12344300163WP0809X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult