Michael Sean Kelly, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95001913 Issued in CA

Practice address

17601 17TH St Ste 120
Tustin, CA 92780-1946

Phone

(714) 769-6090

NPI assigned

Jan 28, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mike.kelly.d1.p8@direct.bfmc.nextgenshare.com
• Direct secure messaging: mike.kelly.p1@direct.lakeside.nextgenshare.com
• Direct secure messaging: mike.kelly.p1@direct.bfmc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Farhad Nikoo Inc

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Lake Forest, CA
  • NPI 1194289868
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1003206004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 SANTA ISABEL AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271509",
            "telephone_number": "949-722-7118",
            "fax_number": "949-722-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17601 17TH ST STE 120",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801946",
            "telephone_number": "714-769-6090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 Victoria St",
            "address_purpose": "LOCATION",
            "city": "Costa Mesa",
            "state": "CA",
            "postal_code": "926271906",
            "country_code": "US",
            "telephone_number": "949-722-7118",
            "fax_number": "949-722-7118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "SEAN",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-28",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95001913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Keith
• Jamie Keller, M.A.
• Megan Renee Keller, LMFT
• Kelly Tran Optometry, Inc
• Joseph Kelly, PHD
• John A Kennedy, BCO
• Ariana Kenney
• Judith A Kent, PH.D.
• Keon-Jung Kim Dental Corporation
• Richard Mallry Kepple, LMFT

• Psychiatric/Mental Health Nurse Practitioner in Tustin, CA
• Providers in Tustin, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.