Active NPI
Grayson Palmer Kelle
- Physician Assistant
- El Cajon, CA
National Provider Identifier
1346028586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 65860
- Practice address
- 1306 Broadway
El Cajon, CA 92021-5810 - Phone
- (619) 551-7400
- NPI assigned
- Sep 19, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 65860 | CA | Primary |
Addresses
Primary practice location
1306 Broadway
El Cajon, CA 92021-5810
Mailing address
9055 Balboa Ave
San Diego, CA 92123-1509
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65860 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750636800000",
"number": "1346028586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9055 BALBOA AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 BROADWAY",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920215810",
"telephone_number": "619-551-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLE",
"first_name": "GRAYSON",
"middle_name": "PALMER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-19",
"last_updated": "2025-06-23",
"certification_date": "2025-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "65860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Cajon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.