Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Thibault, CRNP

Individual provider Pediatric Nurse Practitioner · NPI 1730597360

Kelly Thibault, CRNP is a Nurse Practitioner in Newark, New Jersey. Qualified in 2012, 14 years ago. Practices as a sole proprietor, works from 2 locations and accepts Medicare assignment. Licensed in New Jersey and New York.

Years since qualifying
14
Licensed in
NJ, NY
In the registry since
2014
Specialties on file
2
What do these letters mean?
CRNP — Certified Registered Nurse Practitioner
The title Pennsylvania and some other states use for a nurse practitioner.

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Practice location Address checks out

201 Lyons Ave
Newark, NJ 07112-2027
Phone: (973) 926-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 26NJ0048730 (NJ)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 382415 (NY)

Record details

NPI number1730597360
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNP
Sole proprietorYes
NPI enumeratedJuly 28, 2014
Last updated in NPPESAugust 26, 2025
Certification dateAugust 26, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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