Kelly Rackham, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95015717 Issued in CA

Practice address

1000 Vale Terrace Dr
Vista, CA 92084-5218

Phone

(844) 308-5003

NPI assigned

Nov 3, 2020

Sex

Male

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

Electronic endpoints 4

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

Locations

Interoperability endpoints

• Direct secure messaging: kelly.rackhamnp.p1@direct.vistacommunityclinic.nextgenshare.com
• Direct secure messaging: krackham@vcc.org
• Direct secure messaging: kellyrackham@vucdbaiuc.allscriptsdirect.net

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.

• Vitality Urgent Care a Medical Corporation

  dba Inland Urgent Care

  • Urgent Care Clinic/Center
  • Temecula, CA
  • NPI 1649052218
  NPD
• Vista Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Oceanside, CA
  • NPI 1649363375
  NPD (past)

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

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1801497284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218",
            "telephone_number": "760-631-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218",
            "telephone_number": "844-308-5003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9850 Genesee Ave",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371224",
            "country_code": "US",
            "telephone_number": "858-864-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACKHAM",
        "first_name": "KELLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-03",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BON",
            "identifier": "95015717",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kelly.rackham@Palomarhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2185 Citracado Pkwy",
            "city": "Escondido",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920294159",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "krackham@indianhealth.org",
            "affiliation": "N",
            "endpointDescription": "direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "50100 Golsh Rd",
            "city": "Valley Center",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920825338",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krackham@perlmanclinic.com",
            "affiliation": "Y",
            "affiliationName": "UC San Diego Health - Monica Perlman Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "La Jolla",
            "address_1": "9850 Genesee Ave",
            "city": "LA Jolla",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920371224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krackham@VCC.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1000 Vale Terrace Dr",
            "city": "Vista",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920845218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elma Samantha Quintero, LCSW
• Vanessa Elizabeth Quiroz, NP
• Cheyenne Rohit Rabadia
• Rabbit Hole Therapy
• Rac & Assc, Inc (SpecialCare)
• Rafael E. Cuellar, MD, Inc.
• Sterlie Claire Agorrilla Ragonese, FNP-BC
• Nassrin Rahimi, MD
• Kimberly Rahimian, OTD
• Soudabeh Rahmankhah, MFT

• Family Nurse Practitioner in Vista, CA
• Providers in Vista, 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 Jan 27, 2023; 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.