Provider Demographics
NPI:1649521907
Name:KIVEL, COURTNEY GRACE (CPNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRACE
Last Name:KIVEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BAY AVE
Mailing Address - Street 2:BAYSIDE COMMONS SUITE 101
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2563
Mailing Address - Country:US
Mailing Address - Phone:609-927-4235
Mailing Address - Fax:
Practice Address - Street 1:505 BAY AVE
Practice Address - Street 2:BAYSIDE COMMONS SUITE 101
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2563
Practice Address - Country:US
Practice Address - Phone:609-927-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 643556163W00000X
NJ26NJ00434700363LP0200X
NJ26NR15920700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse