Active NPI
Angelia Kallen, RN
- Registered Nurse
- Jacksonville, FL
National Provider Identifier
1023509577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 9182019
- Practice address
- 12927 Highland Gate Dr
Jacksonville, FL 32224-1663 - Phone
- (386) 846-3551
- NPI assigned
- May 21, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 9182019 | FL | Primary |
Addresses
Primary practice location
12927 Highland Gate Dr
Jacksonville, FL 32224-1663
Mailing address
12927 Highland Gate Dr
Jacksonville, FL 32224-1663
Phone (386) 846-3551
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9182019 | FL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Solutions LLC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571443200000",
"number": "1023509577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12927 HIGHLAND GATE DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241663",
"telephone_number": "386-846-3551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12927 HIGHLAND GATE DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241663",
"telephone_number": "386-846-3551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLEN",
"first_name": "ANGELIA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-21",
"last_updated": "2019-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "FL",
"license": "9182019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.