Provider Demographics
NPI:1629238290
Name:STEPHAN, KELLY CAROLYN (DVM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CAROLYN
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-0220
Mailing Address - Country:US
Mailing Address - Phone:609-298-4600
Mailing Address - Fax:609-298-8091
Practice Address - Street 1:3075 ROUTE 206
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-2042
Practice Address - Country:US
Practice Address - Phone:609-298-4600
Practice Address - Fax:609-298-8091
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29VI00532900174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian