Individual provider Active NPI

Kelley L Scott, NP

  • Nurse Practitioner
  • Fullerton, CA
National Provider Identifier
1366487522
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP11343 Issued in CA
Practice address
1835 Sunny Crest Dr
Fullerton, CA 92835-3616
Phone
(714) 446-5101
NPI assigned
Jun 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP11343 CA Primary

Addresses

Primary practice location

1835 Sunny Crest Dr
Fullerton, CA 92835-3616

Mailing address

1835 Sunny Crest Dr
Fullerton, CA 92835-3616
Phone (714) 446-5101

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041029000885 CA Practitioner - Nurse Practitioner 0749242915 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11343CAMDSpeech-Language Pathologist
NP11343CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince May 1, 2022 Accepting new patients
Providence Medical Foundation CurrentSince May 1, 2022 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Pathway Medical Group, Inc. Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Anaheim, CA 92805
Phone (714) 449-4841

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1835 Sunny Crest Dr
Fullerton, CA 92835
Phone (714) 446-5101

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1366487522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SUNNY CREST DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353616",
            "telephone_number": "714-446-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 SUNNY CREST DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353616",
            "telephone_number": "714-446-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "KELLEY",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP11343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.