Jessica Ray Nunnally

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AG1215007 Issued in CA

Practice address

3544 30TH St
San Diego, CA 92104

Phone

(619) 515-2424

Fax

(619) 683-7570

NPI assigned

Feb 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1073973368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-906-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3544 30TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92104",
            "telephone_number": "619-515-2424",
            "fax_number": "619-683-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNNALLY",
        "first_name": "JESSICA",
        "middle_name": "RAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-29",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "AG1215007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC",
            "identifier": "95003512",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Nungaray Ruvalcaba
• Kristina Maria Nungaray
• Cayleih Nunn, MS RD
• Lynn S Nunn, PHARM.D.
• Robert Gregory Nunn, PH.D., BCBA-D
• Cleo Alexandria Nunnelly
• Sarah Elizabeth Nunnink, PHD - CLINICAL PSYCH
• Aaron Nuno
• Destiny Nuno
• Kelsie Nuno

• Family Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.