Larry Wayne Kelly Jr., PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

183314 Issued in AK

Practice address

1423 Peger Rd
Fairbanks, AK 99709-5169

Phone

(907) 371-1300

NPI assigned

Nov 1, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Anchorage Community Mental Health Services IncGroup PAC ID 1052213089, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Anchorage Community Mental Health Services Inc.

  • Community/Behavioral Health Agency
  • Anchorage, AK
  • NPI 1326268301
  Medicare reassignment Care Compare group NPD
• Anchorage Community Mental Health Services Inc.

  • Community/Behavioral Health Agency
  • Fairbanks, AK
  • NPI 1699354381
  NPD
• Anchorage Community Mental Health Services, Inc

  • Primary Care Nurse Practitioner
  • Fairbanks, AK
  • NPI 1083431688
  NPD

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1487319869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 KINGDOM COME DR",
            "city": "CUMBERLAND",
            "state": "KY",
            "postal_code": "408231547",
            "telephone_number": "606-508-5204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 PEGER RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095169",
            "telephone_number": "907-371-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LARRY",
        "middle_name": "WAYNE",
        "name_suffix": "Jr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "183314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cary S Keller, M.D.
• Joy Keller, CDM
• Ashley Kelley, LPC
• Lamozae Kelley I
• Kimberly Ann Kelly, PH. D., MA, MED
• Myra Lynn Kelly, APRN
• Staysha Kelly
• Terry Kelly, LPC
• Surech Dawn Kemesong
• Elizabeth Angusta Kendall, LMT

• Psychiatric/Mental Health Nurse Practitioner in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.