Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM in Dumont, NJ - Nutritionist

Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM is a Nutritionist - Nutrition, Education based in Dumont, New Jersey. Kathy Ellarene Novella Proctor is licensed to practice in * (Not Available) (license number ) and her current practice location is 182 E Linden Ave, Dumont, New Jersey. She can be reached at her office (for appointments etc.) via phone at (646) 401-3115.

NPI number for Kathy Ellarene Novella Proctor is 1962121251 and her current mailing address is 182 E Linden Ave, Dumont, New Jersey. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1962121251.

Contact Information

	Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM
	182 E Linden Ave, Dumont, NJ 07628-1916
	(646) 401-3115
	(201) 330-4645

Provider's Profile

Full Name	Kathy Ellarene Novella Proctor
Gender	Female
Speciality	Nutritionist - Nutrition, Education
Location	182 E Linden Ave, Dumont, New Jersey
Accepts Medicare Assignments	Does not participate in Medicare Program. She may not accept medicare assignment.

NPI Data:

NPI Number: 1962121251
Provider Enumeration Date: 08/22/2022
Last Update Date: 02/25/2024

Medical Identifiers

Medical identifiers for Kathy Ellarene Novella Proctor such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1962121251	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163WC0400X	Registered Nurse - Case Management	26NR22095100 (New Jersey)	Secondary
163WC0400X	Registered Nurse - Case Management	543566 (New York)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary
133NN1002X	Nutritionist - Nutrition, Education	(* (Not Available))	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kathy Ellarene Novella Proctor is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM 182 E Linden Ave, Dumont, NJ 07628-1916 Ph: (646) 401-3115	Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM 182 E Linden Ave, Dumont, NJ 07628-1916 Ph: (646) 401-3115

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Kathy Ellarene Novella Proctor, MS, BSN, RN- CCM - Nutritionist in Dumont, NJ