Takeysha Kelly, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95029714 Issued in CA

Practice address

350 Terracina Blvd
Redlands, CA 92373-4850

Phone

(909) 335-5000

NPI assigned

Apr 9, 2024

Sex

Female

Sole proprietor

Yes

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 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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Vituity Physician Services PC

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1124884176
  Medicare reassignment

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1497508303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13569 WILLIAMSON RD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392071",
            "telephone_number": "909-240-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 TERRACINA BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734850",
            "telephone_number": "909-335-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TAKEYSHA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95029714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sahara Marie Keaton
• Kelsey Kellar, PT, DPT
• Shannon Ruth Kelleher, MSW
• Kyle Keller, RD
• Maryceleste Kelley
• Kauai Nicole Kennedy-Eto, M,D., MPH
• Casey M. Kennedy, MD
• Britny Rose Kerwin
• Keys Family Resource Center
• Sanaz Khaleghi

• Family Nurse Practitioner in Redlands, CA
• Providers in Redlands, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.