Provider Demographics
NPI:1770573123
Name:HAWLEY, KELLY C (MSN, RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-6309
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1886
Practice Address - Street 1:315 STATE ROUTE 31 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4069
Practice Address - Country:US
Practice Address - Phone:908-689-0777
Practice Address - Fax:908-835-3037
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN84769363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00645982OtherRAILROAD MEDICARE
NJ7891504Medicaid
S38469Medicare UPIN
NJ895469Medicare PIN