Individual ProviderKristen KellyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address55 Schanck Rd, Suite 8a, Freehold, NJ 07728-2964(732) 431-9544PECOS EnrollmentBased on the most recent information from CMS, provider Kristen Kelly does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1457403313Provider TypeIndividualFull NameKelly, KristenCredentialCRNAGenderFemaleSole ProprietorYesEnumeration Date1/18/2007Last Updated1/11/2011Contact InformationPractice LocationPractice Address55 Schanck Rd, Suite 8a, Freehold, NJ 07728-2964Phone(732) 431-9544Fax(732) 431-9313Mailing LocationMailing Address55 Schanck Rd, Suite 8a, Freehold, NJ 07728-2964Phone(732) 431-9544Fax(732) 431-9313Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense26NR08801200New JerseyProvider IdentifiersIDDescriptionIssuerID016539PJNDescriptionOtherIssuerMEDICARE NUMBERNew Jersey