Individual
KELLY THIBAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
26NJ0048730
NJ
363LP0200X
Pediatric Nurse Practitioner
382415
NY
Other
Enumeration date
07/28/2014
Last updated
08/26/2025
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