Lisa-Ann Kelly

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

26NN09168300 Issued in NJ

Practice address

150 Hinchman Ave
Wayne, NJ 07470-2360

Phone

(973) 595-6996

Fax

(973) 595-6706

NPI assigned

Dec 18, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Lisa-Ann Lutz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smalljoys Behavioral Health Services

  • Counselor
  • Wayne, NJ
  • NPI 1548979974
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1235537580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HINCHMAN AVE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702360",
            "telephone_number": "973-595-6996",
            "fax_number": "973-595-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 HINCHMAN AVE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702360",
            "telephone_number": "973-595-6996",
            "fax_number": "973-595-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LISA-ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-18",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NN09168300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7671008",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA-ANN",
            "last_name": "LUTZ",
            "prefix": "MISS",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John J Kearney, MD
• Tracie Kearns
• Nancy Keil
• Andrew Kelley, PT, DPT, CSCS
• Julia Kelly, M.S. CCC-SLP
• Maureen E Kelly
• Michael Edward Kelly, D.C.
• Quinn Elizabeth Kelly
• Jessica L Kelmartin, APN
• Kimberly Ann Kempey, LPC

• Pediatric Nurse Practitioner in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Pediatric Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.