Haruka Kelley

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95007416 Issued in CA

Practice address

2500 Milvia St
Berkeley, CA 94704

Phone

(510) 204-5600

Fax

(510) 506-7722

NPI assigned

Feb 5, 2013

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 identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Contra Costa County

  dba West County Adult Mental Health Services

  • Adult Mental Health Clinic/Center
  • San Pablo, CA
  • NPI 1376620336
  Medicare reassignment
• Humanistic Alternatives to Addiction Research and Treatment, Inc.

  • Methadone Clinic
  • Oakland, CA
  • NPI 1720204696
  NPD (past)

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1770822116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 W EL CAMINO REAL FL 2",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940406203",
            "telephone_number": "510-204-5600",
            "fax_number": "510-506-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 MILVIA ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94704",
            "telephone_number": "510-204-5600",
            "fax_number": "510-506-7722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10850 MacArthur Blvd",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946055266",
            "country_code": "US",
            "telephone_number": "510-875-2300 x233",
            "fax_number": "510-875-2310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "HARUKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-05",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95007416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "NP95007416",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mirjana Kelava, PH.D.
• Lisa J Kelleher, LMFT
• Robin S Keller, PHD
• Gabriella Kellerman, M.D
• Kelley Bryan Gin, PSYD
• Jennifer Marilynn Kelley, DNP
• Eva Rose Kellogg, M.A.
• Jennifer Joy Kelly, PSY.D.
• Kirk Douglas Kelly
• Lauren Kelly

• Primary Care Nurse Practitioner in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.