Provider Demographics
NPI:1790159556
Name:ALICEA, KEILYNN (APN)
Entity Type:Individual
Prefix:
First Name:KEILYNN
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J2 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3340
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-4628
Practice Address - Street 1:2575 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-2801
Practice Address - Country:US
Practice Address - Phone:609-681-5241
Practice Address - Fax:609-631-6888
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR16177800163W00000X
NJ26NJ00615500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse