Active NPI
Jade Midori Kelley, RD
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1922646397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86106236
- Practice address
- 3020 Childrens Way
San Diego, CA 92123-4223 - Phone
- (858) 576-1700
- NPI assigned
- Dec 17, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86106236 | CA | Primary |
Addresses
Primary practice location
3020 Childrens Way
San Diego, CA 92123-4223
Mailing address
1135 Hemlock Ave
Imperial Beach, CA 91932-3520
Phone (619) 207-9180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86106236 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576540800000",
"number": "1922646397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1135 HEMLOCK AVE",
"city": "IMPERIAL BEACH",
"state": "CA",
"postal_code": "919323520",
"telephone_number": "619-207-9180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-576-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "JADE",
"middle_name": "MIDORI",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-17",
"last_updated": "2019-12-17",
"certification_date": "2019-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86106236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.