Provider Demographics
NPI:1588029730
Name:GONZALEZ, KYLEE (APN)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:L
Other - Last Name:STAHLNECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22 COURT ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1700
Mailing Address - Country:US
Mailing Address - Phone:732-780-7387
Mailing Address - Fax:
Practice Address - Street 1:22 COURT ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1700
Practice Address - Country:US
Practice Address - Phone:732-780-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646542163W00000X
NJ26NJ00846600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse