Active NPI
Tim Ray Kelly
- Peer Specialist
- Lincoln City, OR
National Provider Identifier
1003535386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000106995
- Practice address
- 1221 NW Highway 101 Ste a
Lincoln City, OR 97367-3351 - Phone
- (442) 244-1336
- NPI assigned
- Aug 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000106995 | OR | Primary |
Addresses
Primary practice location
1221 NW Highway 101 Ste a
Lincoln City, OR 97367-3351
Mailing address
1221 NW Highway 101 Ste a
Lincoln City, OR 97367-3351
Phone (971) 727-5471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW000106995 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661126400000",
"number": "1003535386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 NW HIGHWAY 101 STE A",
"city": "LINCOLN CITY",
"state": "OR",
"postal_code": "973673351",
"telephone_number": "971-727-5471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 NW HIGHWAY 101 STE A",
"city": "LINCOLN CITY",
"state": "OR",
"postal_code": "973673351",
"telephone_number": "442-244-1336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TIM",
"middle_name": "RAY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-22",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000106995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.