KELLY THIBAULT CRNP
NPI 1730597360
Nurse Practitioner - Pediatrics in Newark, NJ
About Kelly Thibault Crnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY THIBAULT CRNP (NPI 1730597360) is an individual pediatrics provider in Newark, New Jersey, licensed in New Jersey (26NJ0048730) and active in the NPI registry since July 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2012).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelly Thibault Crnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 07112 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
NEWARK, NJ 07112
NEWARK, NJ 07112
NEWARK, NJ 07112
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Thibault's NPI number?
The NPI number for Kelly Thibault is 1730597360. It was assigned to this individual provider in the NPPES registry on July 28, 2014.
Where is Kelly Thibault located?
Kelly Thibault practices at 201 Lyons Ave, Newark, NJ 07112. The listed phone number is (973) 926-7000.
What is Kelly Thibault's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Kelly Thibault enrolled in Medicare?
Yes. Kelly Thibault is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Kelly Thibault was last updated on August 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Thibault, CRNP · NPI 1730597360
Pediatrics physician in Newark, New Jersey. Individual provider, active in the CMS NPPES registry since July 28, 2014.
## Identity
- **NPI:** 1730597360 (Entity type: Individual)
- **Enumerated:** July 28, 2014
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 26NJ0048730 (New Jersey)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 201 LYONS AVE, Newark, NJ 07112-2027
- **Phone:** (973) 926-7000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2012
## Record status
- **NPPES last updated:** August 26, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1730597360) · Data from the CMS NPPES public registry.