Provider Demographics
NPI:1578007746
Name:GELDER, KIMBERLY BLAKE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BLAKE
Last Name:GELDER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:BLAKE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000 CL# 4480
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4480
Mailing Address - Country:US
Mailing Address - Phone:973-873-7000
Mailing Address - Fax:973-873-7035
Practice Address - Street 1:2401 E EVESHAM RD STE F
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9590
Practice Address - Country:US
Practice Address - Phone:773-882-7788
Practice Address - Fax:856-424-7529
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18011900363LA2200X
NJ26NJ00691200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicaid