Individual provider · Type 1 NPI

Kelly Thibault, CRNP

Pediatric Nurse Practitioner · Newark, NJ

NPI number 1730597360 Active

Practice location

201 Lyons Ave
Newark, NJ 07112-2027

Mailing address

60 Oak Pl
Fair Haven, NJ 07704-3510

Other practice locations

  • 3601 A St, Philadelphia, PA 19134-1043 · (215) 427-5000

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner 363LP0200X382415 (NY)
Pediatric Nurse Practitioner Primary 363LP0200X26NJ0048730 (NJ)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1730597360

Kelly Thibault, CRNP's National Provider Identifier is 1730597360, issued on Jul 28, 2014. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Newark, NJ. The record was last updated on Aug 26, 2025.