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

Kelly Vanwyck

Individual provider Family Nurse Practitioner · NPI 1104334655

Kelly Vanwyck is a Nurse Practitioner in Randolph, New Jersey. Qualified in 2017, 9 years ago. Practices with Vanguard Medical Group PA, a 60-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
9
Licensed in
NJ
In the registry since
2018

Practice location Address checks out

477 Route 10 Ste 205
Randolph, NJ 07869-2144
Phone: (973) 560-9500
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 26NJ00792600 (NJ)

Record details

NPI number1104334655
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 18, 2018
Last updated in NPPESJanuary 18, 2018
Mailing address700 Route 46 E Ste 450, Fairfield, NJ 07004-1583

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Vanguard Medical Group Pa — 60 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Randolph