NPIMap

Individual provider Active NPI

Kelly Vaughan Hall, ADVANCED NURSE PRACT

  • Family Nurse Practitioner
  • Soldotna, AK
National Provider Identifier
1518213503
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1311 Issued in AK
Practice address
44604 Sterling Hwy Ste D
Soldotna, AK 99669-7962
Phone
(907) 420-0585
Fax
(907) 420-0586
NPI assigned
Jul 27, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1311 AK Primary

Addresses

Primary practice location

44604 Sterling Hwy Ste D
Soldotna, AK 99669-7962

Mailing address

44604 Sterling Hwy Ste D
Soldotna, AK 99669-7962
Phone (907) 538-5638

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120914000474 TX Practitioner - Nurse Practitioner 0547418659 Reassigns benefits to 1 organization
I20160209002446 AK Practitioner - Nurse Practitioner 0547418659 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Urgent Care of Soldotna IncGroup PAC ID 5698101194, 5 clinicians

Practice addresses (Care Compare)

1700 E Bogard Rd
Wasilla, AK 99654-6570
Phone (907) 921-5088

44009 Sterling Hwy
Suite a
Soldotna, AK 99669-8030
Phone (907) 420-0585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1311AKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Care of Soldotna Inc. CurrentSince May 1, 2021 Accepting new patients
Independence Healthcare PC CurrentSince Jan 1, 2019 Accepting new patients
Soldotna Family Practice LLC CurrentSince Apr 1, 2023 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Sep 4, 2012 Accepting new patients
Independence Healthcare PC CurrentSince Jan 1, 2019 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000

130 S Willow St
Ste 1
Kenai, AK 99611
Phone (907) 262-2596

44009 Sterling Hwy
Soldotna, AK 99669

289 N Fireweed St
Ste D
Soldotna, AK 99669
Phone (907) 262-6454

44604 Sterling Hwy
Ste D
Soldotna, AK 99669
Phone (907) 420-0476

291 N Fireweed St
Soldotna, AK 99669
Phone (907) 262-6454

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20934/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1518213503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44604 STERLING HWY STE D",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697962",
            "telephone_number": "907-538-5638",
            "fax_number": "907-420-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44604 STERLING HWY STE D",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697962",
            "telephone_number": "907-420-0585",
            "fax_number": "907-420-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "KELLY",
        "middle_name": "VAUGHAN",
        "name_prefix": "Ms.",
        "credential": "ADVANCED NURSE PRACT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2023-04-12",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "1311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

Verify at the official NPI Registry.