Mary Gay Kelley, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP0029 Issued in AZ

Practice address

12425 W Bell Rd
Suite 200
Surprise, AZ 85378-9006

Phone

(623) 374-7774

Fax

(623) 240-1110

NPI assigned

Sep 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1164416277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 W BELL RD",
            "address_2": "SUITE 200",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789006",
            "telephone_number": "623-374-7774",
            "fax_number": "623-240-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12425 W BELL RD",
            "address_2": "SUITE 200",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789006",
            "telephone_number": "623-374-7774",
            "fax_number": "623-240-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARY",
        "middle_name": "GAY",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "AP0029",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP2547",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "293709",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00457902",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keen Eye Center LLC
• Kaitlyn Sue Keicher
• Jennifer Anne Keiser, LCSW
• Kathleen Joan Keller, COTA/L
• Cathy Eileen Kelley, LCSW
• Lawrence J Kelly, MD
• Richard Charles Kennard, FNP
• Jim W Kester, P.T.
• Timothy Keur
• Nabilah Keys, OTA/L

• Gerontology Nurse Practitioner in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.