Nan Marie Kelly, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

216481 Issued in CA

Practice address

44225 Barbara TRL
Aguanga, CA 92536-9654

Phone

(951) 763-5634

Fax

(951) 763-5634

NPI assigned

Sep 30, 2006

Last updated

Nov 3, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Nan Marie Kelly Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

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  NPD (past)

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1659464071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 391700",
            "address_2": "ANZA COMMUNITY CLINIC",
            "city": "ANZA",
            "state": "CA",
            "postal_code": "925391700",
            "telephone_number": "951-763-5000",
            "fax_number": "951-763-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44225 BARBARA TRL",
            "city": "AGUANGA",
            "state": "CA",
            "postal_code": "925369654",
            "telephone_number": "951-763-5634",
            "fax_number": "951-763-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NAN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-30",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "216481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NAN",
            "last_name": "KELLY",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "N.P.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Megan Estrada, M.S. CCC-SLP
• Mary Bridgid Foye, MSN, FNP, NP-C
• John Stafford LLC
• Michelle Lopez
• Mindful Moments Life Coaching LLC
• Clara Berlanga Ocampo
• Sheila K Oconnor, MFT
• Cara Nicole Sather, NP

• Family Nurse Practitioner in Aguanga, CA
• Providers in Aguanga, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.