Active NPI
Serena Lachelle Kelly
- Nurse Practitioner
- Antioch, CA
National Provider Identifier
1356212898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95026231
- Practice address
- 1960 Mokelumne Dr
Antioch, CA 94531-9139 - Phone
- (925) 354-2402
- NPI assigned
- Sep 17, 2025
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95026231 | CA | Primary |
Addresses
Primary practice location
1960 Mokelumne Dr
Antioch, CA 94531-9139
Mailing address
1960 Mokelumne Dr
Antioch, CA 94531-9139
Phone (925) 354-2402
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95026231 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1356212898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1960 MOKELUMNE DR",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945319139",
"telephone_number": "925-354-2402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1960 MOKELUMNE DR",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945319139",
"telephone_number": "925-354-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "SERENA",
"middle_name": "LACHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-17",
"last_updated": "2025-10-24",
"certification_date": "2025-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95026231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.