Jacqueline Ann Kelly, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

33918 Issued in ZZ

Practice address

206 3Rd St NW
Mohall, ND 58761-4105

Phone

(306) 540-7407

NPI assigned

Feb 22, 2022

Last updated

Feb 22, 2022By the provider in NPPES

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 names 1

• Jacqueline Ann Tisher Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1972259505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 811",
            "city": "MOHALL",
            "state": "ND",
            "postal_code": "587610811",
            "telephone_number": "306-540-7407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 3RD ST NW",
            "city": "MOHALL",
            "state": "ND",
            "postal_code": "587614105",
            "telephone_number": "306-540-7407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-22",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ZZ",
            "license": "33918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "TISHER",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Virginia Jean Engh, D.C.
• Kayla Fisher, M.S CCC-SLP
• Rachel Hanson
• Paul Daniel Herigstad, DC
• Vera Jones
• Jan Jessie McLean
• Mohall Ambulance Service
• Prairie Home and Health LLC
• Renville County Social Services
• Peggy Ring

• Registered Nurse in Mohall, ND
• Providers in Mohall, ND by specialty
• Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.