Provider Demographics
NPI:1598332819
Name:BARRAMEDA, KELLY (APN, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BARRAMEDA
Suffix:
Gender:F
Credentials:APN, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2139
Mailing Address - Country:US
Mailing Address - Phone:973-945-3816
Mailing Address - Fax:
Practice Address - Street 1:100 WALNUT AVE # 610
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1253
Practice Address - Country:US
Practice Address - Phone:908-583-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR21697500163W00000X
NJ26NJ01292100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse