Active NPI
Patricia L Kelly, M.D.
- Psychiatry Physician
- Albuquerque, NM
National Provider Identifier
1194924530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 41064
- Practice address
- 2305 Matthew Ave NW
Albuquerque, NM 87104-3214 - Phone
- (505) 463-1228
- Fax
- (505) 243-3921
- NPI assigned
- Jul 16, 2007
- Last updated
- May 8, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | 98-302 | NM | |
| Psychiatry Physician | 2084P0800X | 41064 | CT | Primary |
Addresses
Primary practice location
2305 Matthew Ave NW
Albuquerque, NM 87104-3214
Mailing address
PO Box 27746
Albuquerque, NM 87125-7746
Phone (505) 463-1228
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41064 | CT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367971200000",
"number": "1194924530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27746",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871257746",
"telephone_number": "505-463-1228",
"fax_number": "505-243-3921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2305 MATTHEW AVE NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871043214",
"telephone_number": "505-463-1228",
"fax_number": "505-243-3921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "PATRICIA",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-16",
"last_updated": "2013-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "NM",
"license": "98-302",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "41064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.