Jacqueline Kelly

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024165999 Issued in VA

Practice address

400 Gresham Dr
Suite 303
Norfolk, VA 23507-1901

Phone

(757) 627-6416

NPI assigned

Oct 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SE Virginia Value Based Care LLCGroup PAC ID 6103288170, 160 clinicians

Mid-Atlantic Post Acute and Long Term Care PLLCGroup PAC ID 0648530782, 142 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid-Atlantic Post Acute & Long Term Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225557556

  Family

  Medicare reassignment Care Compare group NPD
• SE Virginia Value Based Care, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225720501
  Medicare reassignment Care Compare group
• J&C Healthcare Services LLC

  • Home Health Agency
  • VA Beach, VA
  • NPI 1073035432
  NPD

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124109624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR",
            "address_2": "SUITE 303",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-627-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR",
            "address_2": "SUITE 303",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-627-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024165999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina L. Kelley, RDH
• Nathaniel Kelley, LPC
• Alison M. Kelly, CRNA
• Caitlin Kelly, LPC
• Cynthia S Kelly, M.D.
• James Joseph Kelly Jr., RPH.
• Lucy Page Kelly, DO
• Robert E. Kelly Jr., M.D.
• Tara Harman Kelly, PHD, RDN
• Tavia Kelly, DPT

• Family Nurse Practitioner in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.