Dan Dale Kelly

Primary specialty

Adult CompanionTaxonomy code 372600000X

Practice address

120 Birch St
Shady Cove, OR 97539

Phone

(541) 878-2429

NPI assigned

May 17, 2010

Last updated

May 17, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1274054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1285952101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1516",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "97539",
            "telephone_number": "541-878-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BIRCH ST",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "97539",
            "telephone_number": "541-878-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DAN",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-17",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Finley
• Kristen Ranae Gerhardt
• Rhonda Grayson
• Kathleen S Finley (Shady Cove Clinic)
• Kelly Clayton FNP Inc (Health Care By House Call)
• Phillip Bruce Lassen, D.M.D.
• Laura L. Johnson, N.P., P.C. (Crater Lake Medical South)
• Mending Waters Counseling LLC
• Lila R Moschetti, RPH
• Luke B Murphy, DMD

• Adult Companion in Shady Cove, OR
• Providers in Shady Cove, OR by specialty
• Adult Companion in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; 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.