Individual provider Active NPI

Kelsie Gilley, APRN

  • Family Nurse Practitioner
  • Beaumont, TX
National Provider Identifier
1023623964
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1012347 Issued in TX
Practice address
4347 Phelan Blvd Ste 101
Beaumont, TX 77707-2159
Phone
(409) 767-9285
NPI assigned
Sep 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1012347 TX Primary

Addresses

Primary practice location

4347 Phelan Blvd Ste 101
Beaumont, TX 77707-2159

Mailing address

4347 Phelan Blvd Ste 101
Beaumont, TX 77707-2159
Phone (409) 767-9285

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210127000058 TX Practitioner - Nurse Practitioner 7315351749 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1012347TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Anywhere, PLLC Family CurrentSince Jan 1, 2021 Accepting new patients
Texas Health Foundation, Inc CurrentSince Jan 26, 2026 Accepting new patients
Fairmount Family Practice, PLLC PastSince Sep 1, 2020 Accepting new patients
Pca Setx LLC PastSince Jun 3, 2025 Accepting new patients

Locations

3610 Stagg Dr
Beaumont, TX 77701
Phone (409) 730-4700

4347 Phelan Blvd
Ste 101
Beaumont, TX 77707
Phone (409) 767-8686

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CDIIDD/Endpoint/CDIIDD

Organizations & group practices 4

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": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1023623964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4347 PHELAN BLVD STE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777072159",
            "telephone_number": "409-767-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4347 PHELAN BLVD STE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777072159",
            "telephone_number": "409-767-9285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLEY",
        "first_name": "KELSIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1012347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.