Active NPI
Kelli Ann Vickrey, FNP-C
- Family Nurse Practitioner
- Fort Worth, TX
National Provider Identifier
1255984837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP142103
- Practice address
- 6440 Rendon Bloodworth Rd
Fort Worth, TX 76140-9448 - Phone
- (817) 662-2550
- Fax
- (817) 612-3214
- NPI assigned
- Jul 22, 2019
- Last updated
- May 9, 2023
- 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 | AP142103 | TX | Primary |
Addresses
Primary practice location
6440 Rendon Bloodworth Rd
Fort Worth, TX 76140-9448
Mailing address
6440 Rendon Bloodworth Rd
Fort Worth, TX 76140-9448
Phone (817) 662-2550
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
- Opted out of Medicare
- Yes, effective Apr 6, 2020 through Apr 6, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP142103 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683590400000",
"number": "1255984837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6440 RENDON BLOODWORTH RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761409448",
"telephone_number": "817-662-2550",
"fax_number": "817-612-3214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6440 RENDON BLOODWORTH RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761409448",
"telephone_number": "817-662-2550",
"fax_number": "817-612-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKREY",
"first_name": "KELLI",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-22",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP142103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.