Kevin Eric Kelly, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

19354 Issued in CA

Practice address

368 Fell St
San Francisco, CA 94102-5144

Phone

(415) 861-0828

Fax

(415) 861-0257

NPI assigned

Oct 5, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1235464447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 FELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025144",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 FELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025144",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "ERIC",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-05",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "3269",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "19354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Margaret Mary Kelly, MD
• James Damian Kelly II, MD
• Josephine Kelly, MSW, ACSW
• Joshua Kelly, M.A.
• Kerry Ann Kelly
• Knox Kelly
• Madeline Kelly
• Madelyn Vone'E Kelly
• Mary Jill Kelly, SSPS
• Molly E. Kelly, MD

• Psychiatric/Mental Health Nurse Practitioner in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.

Verify at the official NPI Registry.