Jacqueline Mary Kelly, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

381614 Issued in NY

Practice address

300 4TH St
Danville, WV 25053-4632

Phone

(304) 369-1230

NPI assigned

Oct 25, 2021

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

Medicare fee-for-service enrollment

Enrolled in WV, NY2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkelly164438@direct.upstate.edu

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.

• Boone Memorial Hospital, Inc

  dba Boone Memorial Hospital

  • Multi-Specialty Clinic/Center
  • Madison, WV
  • NPI 1285686725
  Medicare reassignment NPD
• Suny Health Science Center at Syracuse

  dba Upstate University Hospital

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1184974529

  Pediatrics

  Medicare reassignment NPD
• Boone Memorial Hospital, Inc

  dba BMH Comfort Clinic

  • Rural Health Clinic/Center
  • Comfort, WV
  • NPI 1407421431
  NPD
• Boone Memorial Hospital, Inc

  dba BMH Brighter Futures

  • Psychiatry Physician
  • Madison, WV
  • NPI 1871141366
  NPD
• Suny Health Science Center at Syracuse

  dba Upstate Outpatient Pharmacy at Nappi

  • Pharmacy
  • Syracuse, NY
  • NPI 1306567474
  NPD

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1811651052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 FELLOWS AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102625",
            "telephone_number": "315-877-8055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 4TH ST",
            "city": "DANVILLE",
            "state": "WV",
            "postal_code": "250534632",
            "telephone_number": "304-369-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACQUELINE",
        "middle_name": "MARY",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "381614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joyce Ann Johnson
• Lindsey Johnson
• Whitney Johnson
• Vanna Noel Jones
• Tiffany Jude
• Kenmore Leasing Co., LLC (Hillcrest Healthcare Center)
• Kesari MD Inc
• Hana Kessler
• Matthew Russell Kincaid, PHARM.D
• Delana F Kinser

• Pediatric Nurse Practitioner in Danville, WV
• Providers in Danville, WV by specialty
• Pediatric Nurse Practitioner in West Virginia

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

Verify at the official NPI Registry.