Active NPI
Kaely Owen
- Family Nurse Practitioner
- Riverside, CA
National Provider Identifier
1730634270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95004779
- Practice address
- 7117 Brockton Ave
Riverside, CA 92506-2658 - Phone
- (951) 683-6370
- NPI assigned
- Aug 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 801616 | CA | |
| Family Nurse Practitioner | 363LF0000X | 95004779 | CA | Primary |
Addresses
Primary practice location
7117 Brockton Ave
Riverside, CA 92506-2658
Mailing address
7117 Brockton Ave
Riverside, CA 92506-2658
Phone (951) 683-6370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 801616 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472256000000",
"number": "1730634270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7117 BROCKTON AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925062658",
"telephone_number": "951-683-6370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7117 BROCKTON AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925062658",
"telephone_number": "951-683-6370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OWEN",
"first_name": "KAELY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-24",
"last_updated": "2016-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "801616",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95004779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.