Provider Demographics
NPI:1518592963
Name:ALLEN, KELSEY JANE (NP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1221
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:
Practice Address - Street 1:2605 SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2136
Practice Address - Country:US
Practice Address - Phone:609-365-5333
Practice Address - Fax:609-365-5306
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00987100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0734454Medicaid