Kelli Kaye Hernandez, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA21159 Issued in CA

Practice address

700 S Tustin St
Orange, CA 92866-3425

Phone

(714) 922-4100

NPI assigned

Oct 7, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Kelli Kaye Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1639489727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928663425",
            "telephone_number": "714-922-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928663425",
            "telephone_number": "714-922-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "KELLI",
        "middle_name": "KAYE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-07",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21159",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "WILSON",
            "middle_name": "KAYE",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Juan Pablo Hernandez
• Justin Phillip Hernandez
• Karen Margaret Hernandez
• Karina Hernandez
• Karla Hernandez
• Leslie Hernandez
• Lillie May Hernandez
• Linda Guadalupe Hernandez
• Lizette Hernandez
• Maria Hernandez

• Medical Physician Assistant in Orange, CA
• Providers in Orange, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.