Jackson Kelly

Primary specialty

PharmacistTaxonomy code 183500000X

License

RP00007679 Issued in NM

Practice address

2211 Lomas Blvd NE
Anticoagulation Clinic, Main Hospital Second Floor
Albuquerque, NM 87106-2719

Phone

(505) 272-6202

Fax

(505) 272-4882

NPI assigned

Aug 29, 2011

Last updated

Jul 21, 2023By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Unm Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1689747552
  NPD (past)

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1578843009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 BRADBURY DR SE",
            "address_2": "SUITE 2222",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064374",
            "telephone_number": "505-272-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "address_2": "ANTICOAGULATION CLINIC, MAIN HOSPITAL SECOND FLOOR",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062719",
            "telephone_number": "505-272-6202",
            "fax_number": "505-272-4882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACKSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-29",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "RP00007679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMH@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "2211 Lomas Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871062719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Bingham Kelly, CFNP CDE
• Catherine Marie Kelly, CCC-SLP
• Christopher Kelly, MD
• Elizabeth Kelly
• Heather Kelly, SLP
• James Edward Breandan Kelly IV, MD
• Jeremiah F Kelly, M.D.
• Leslie Kelly, LPC
• Linda R Kelly, PHARMD PHC
• Maria Kelly

• Pharmacist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Pharmacist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.