Provider Demographics
NPI:1740260181
Name:MCCOURT, KIMBERLY JEAN (APNC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201B RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2156
Mailing Address - Country:US
Mailing Address - Phone:732-295-8084
Mailing Address - Fax:
Practice Address - Street 1:1945 RTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4196
Practice Address - Fax:732-776-2488
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09044900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS49009Medicare UPIN