| NPI | 1558325183 |
|---|---|
| Former Name | TISHA ANN KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00106300) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP008917) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-05-05 |