Individual provider Active NPI

Kellee A Etghayi, A.P.R.N.

  • Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1891225116
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
23140 Issued in TN
Practice address
951 NW 13TH St Ste 5B
Boca Raton, FL 33486-2337
Phone
(561) 235-5621
NPI assigned
Jun 19, 2017
Last updated
Feb 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 23140 TN Primary

Addresses

Primary practice location

951 NW 13TH St Ste 5B
Boca Raton, FL 33486-2337

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 425-5752

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20180108001584 TN Practitioner - Nurse Practitioner 0042579526

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Suite 400
Jackson, TN 38302-0400

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
74.15
Promoting interoperability
77
Improvement activities
40
Cost
78.84

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23140TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Clinic PA CurrentSince Sep 14, 2017 Accepting new patients
Jackson Clinic PA CurrentSince Sep 14, 2017 Accepting new patients

Locations

145 Innovation Dr
Jackson, TN 38305

2863 Highway 45 Byp
Jackson, TN 38305
Phone (731) 660-8300

700 W Forest Ave
Jackson, TN 38301
Phone (731) 424-8922

700 W Forest Ave
Ste 300
Jackson, TN 38301
Phone (731) 422-0330

87 Murray Guard Dr
Ste B
Jackson, TN 38305
Phone (731) 664-1375

Interoperability endpoints

  • Direct secure messaging: kelleeetghayi@jcpa.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1891225116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-425-5752",
            "fax_number": "731-425-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 NW 13TH ST STE 5B",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334862337",
            "telephone_number": "561-235-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETGHAYI",
        "first_name": "KELLEE",
        "middle_name": "A",
        "credential": "A.P.R.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "23140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.