Evelyn G Kelley

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95022181 Issued in CA

Practice address

30420 Haun Rd
Menifee, CA 92584-6810

Phone

(951) 676-4193

NPI assigned

Apr 21, 2021

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

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

Specialty

Nurse Practitioner

Education

Loma Linda University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Rancho Family Medical Group IncGroup PAC ID 6305741240, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Rancho Family Medical Group, Inc.

  dba Platinum Women's Health and Wellness

  • Family Medicine Physician
  • Temecula, CA
  • NPI 1598791600
  Medicare reassignment Care Compare group NPD
• Regents of the University of California

  dba Ucsd Medical Center Pharmacy

  • Pharmacy
  • San Diego, CA
  • NPI 1598786576
  NPD (past)
• Rincon Health Network

  • Health Service Clinic/Center
  • Temecula, CA
  • NPI 1902697832
  NPD (past)
• UC San Diego Health - Rancho Family Medical Group

  • Multi-Specialty Clinic/Center
  • Temecula, CA
  • NPI 1003385071
  NPD (past)

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1710569694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28780 SINGLE OAK DR STE 160",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30420 HAUN RD",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846810",
            "telephone_number": "951-676-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "EVELYN",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2024-03-06",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95022181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Kamotho
• Sangwon Kang
• Stanley Karanja Kariuki
• Tom Mutungi Kasivau
• Ashley Keeton
• Richard George Kennedy, D.D.S.
• Sandra Michel Keroles
• Kelsey Taylor Kesel, DPT
• Thay Kieu, RDH
• Grace Kim

• Family Nurse Practitioner in Menifee, CA
• Providers in Menifee, 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 Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.