Provider Demographics
NPI:1720325301
Name:OKUSANYA, KATE A (NP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:A
Last Name:OKUSANYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PEACH TREE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1559
Mailing Address - Country:US
Mailing Address - Phone:908-304-5313
Mailing Address - Fax:973-585-4229
Practice Address - Street 1:47 PEACH TREE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1559
Practice Address - Country:US
Practice Address - Phone:908-304-5313
Practice Address - Fax:973-585-4229
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJOO407600363LP2300X
NJ26NJ00407600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0596124Medicaid