Active NPI
Jacqueline Kelly
- Family Nurse Practitioner
- Lakeport, CA
National Provider Identifier
1235077694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F02260054
- Practice address
- 925 Bevins CT
Lakeport, CA 95453-9754 - Phone
- (707) 263-8382
- NPI assigned
- Mar 24, 2026
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F02260054 | CA | Primary |
Addresses
Primary practice location
925 Bevins CT
Lakeport, CA 95453-9754
Mailing address
PO Box 516
Clearlake Oaks, CA 95423-0516
Phone (916) 613-0098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F02260054 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potential Way | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Lodging Provider
- Clearlake Oaks, CA
- NPI 1588434849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774310400000",
"number": "1235077694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 516",
"city": "CLEARLAKE OAKS",
"state": "CA",
"postal_code": "954230516",
"telephone_number": "916-613-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 BEVINS CT",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954539754",
"telephone_number": "707-263-8382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-24",
"last_updated": "2026-03-24",
"certification_date": "2026-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "F02260054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeport, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; 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.