Individual
KELLY O'DONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
385 MORRIS AVE FL 2, SPRINGFIELD, NJ 07081-1151
(973) 329-2111
(973) 379-2807
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00288700
NJ
363AM0700X
Medical Physician Assistant
25MP00288700
NJ
Other
Enumeration date
09/18/2012
Last updated
05/23/2023
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