Individual provider Active NPI

Kelly Jean Cook, NURSE PRACTITIONER

  • Acute Care Nurse Practitioner
  • Burlingame, CA
National Provider Identifier
1609173046
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
18283 Issued in CA
Practice address
1501 Trousdale Dr FL 2
Burlingame, CA 94010-4506
Phone
(650) 652-8600
NPI assigned
Feb 22, 2011
Last updated
Jun 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 18283 CA Primary

Addresses

Primary practice location

1501 Trousdale Dr FL 2
Burlingame, CA 94010-4506

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 652-8600

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110719000378 CA Practitioner - Nurse Practitioner 4183892110 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18283CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Mar 1, 2020 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Mar 1, 2020 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Mar 1, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Mar 1, 2020 Accepting new patients

Locations

1501 Trousdale Dr
Burlingame, CA 94010
Phone (650) 696-3520

1501 Trousdale Dr
Fl 2
Burlingame, CA 94010
Phone (650) 652-8310

3120 Kearney St
Fremont, CA 94538
Phone (650) 498-3600

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

701 E El Camino Real
#1
Mountain View, CA 94040
Phone (650) 404-8440

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 780-0110

301 Industrial Rd
#1
San Carlos, CA 94070
Phone (650) 404-8455

2581 Samaritan Dr
Ste 308
San Jose, CA 95124
Phone (408) 355-1700

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1609173046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-652-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 TROUSDALE DR FL 2",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940104506",
            "telephone_number": "650-652-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "18283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlingame, CA

Sources for this page

Verify at the official NPI Registry.