Christine Kelly, APN-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ00701200 Issued in NJ

Practice address

2475 McClellan Ave
Pennsauken, NJ 08109-4683

Phone

(856) 675-3355

NPI assigned

Jan 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ckelly3830439@direct.trinity-health.org

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.

• Life at Lourdes Inc

  • PACE Provider Organization
  • Pennsauken, NJ
  • NPI 1063662187
  NPD (past)
• Lourdes Cardiology Services, P.C.

  • Cardiovascular Disease Physician
  • Cherry Hill, NJ
  • NPI 1912202557
  NPD (past)

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1295272821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 MCCLELLAN AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081094683",
            "telephone_number": "856-675-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 MCCLELLAN AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081094683",
            "telephone_number": "856-675-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHRISTINE",
        "credential": "APN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-20",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00701200",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "MK4283696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "trinity.health.life.new.jersey@trinityhealthpa.medicity.net",
            "affiliation": "N",
            "endpointDescription": "Trinity Health LIFE-NJ",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CCD",
            "address_1": "2475 McClellan Ave",
            "city": "Pennsauken",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081094683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marquia S Jones, LAC
• Michael Jones
• Tatyana Kaganova, D.M.D., M.S.
• Ashlyn Kang, PHARMD
• KDG Operating Company, LLC
• Dara Kelly
• Aurangzaib Khan, DDS
• Marlon Ingaywa Kidiiga, PHARM.D.
• King of Rock Drywall and Finishing LLC
• Taniyah King-Pulliam

• Gerontology Nurse Practitioner in Pennsauken, NJ
• Providers in Pennsauken, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.