Active NPI
Kelly S McDonough, RN
- Registered Nurse
- San Diego, CA
National Provider Identifier
1104578533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 821911
- Practice address
- 5811 Henley Dr
San Diego, CA 92120-4520 - Phone
- (619) 952-4030
- NPI assigned
- Jan 26, 2022
- 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 | 821911 | CA | Primary |
Addresses
Primary practice location
5811 Henley Dr
San Diego, CA 92120-4520
Mailing address
5811 Henley Dr
San Diego, CA 92120-4520
Phone (619) 952-4030
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 |
|---|---|---|---|
| 821911 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1104578533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5811 HENLEY DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921204520",
"telephone_number": "619-952-4030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5811 HENLEY DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921204520",
"telephone_number": "619-952-4030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONOUGH",
"first_name": "KELLY",
"middle_name": "S",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-26",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "821911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.