Kellie Nielsen, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

296763 Issued in CA

Practice address

803 Russell Blvd
Davis, CA 95616-3426

Phone

(530) 391-8670

NPI assigned

Jul 22, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1548813280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3436 SACKETT LN",
            "city": "WINTERS",
            "state": "CA",
            "postal_code": "956949687",
            "telephone_number": "206-518-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 RUSSELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163426",
            "telephone_number": "530-391-8670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "KELLIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "CA",
            "license": "296763",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "296763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY BOARD OF CALIFORNIA",
            "identifier": "296763",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Nham, DO
• Phoebe Ann Nicholas
• Jacqueline Nichols, NP
• Amoret E. Nicklisch, PA-C
• Macara Marie Nicoll
• Nightingale Medical Centers, Inc.
• Francesca Nikolic
• Laila Niyati
• Sara Niyati, O.D.
• Mariana Nogueira de Andrade

• Pediatric Physical Therapist in Davis, CA
• Providers in Davis, CA by specialty
• Pediatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.