Kerry Melachouris, RN PMHNP STUDENT

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

698539 Issued in CA

Practice address

30862 La Mer
Laguna Niguel, CA 92677-5511

Phone

(949) 697-0960

NPI assigned

Apr 21, 2022

Reactivated

Aug 1, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1760126353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30862 LA MER",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775511",
            "telephone_number": "949-697-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30862 LA MER",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775511",
            "telephone_number": "949-697-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELACHOURIS",
        "first_name": "KERRY",
        "credential": "RN PMHNP STUDENT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-21",
        "last_updated": "2024-08-01",
        "certification_date": "2023-02-22",
        "deactivation_date": "2023-02-22",
        "reactivation_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "698539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Registered Nurse in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.