Provider Demographics
NPI:1407311830
Name:MULVEY, KRISTI L (CPNP-AC/PC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:MULVEY
Suffix:
Gender:F
Credentials:CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1863
Mailing Address - Country:US
Mailing Address - Phone:908-812-4074
Mailing Address - Fax:
Practice Address - Street 1:300 2ND AVE STE SH013
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6091
Practice Address - Fax:732-923-6092
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00899700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics