MR. MICHAEL SEAN KELLY NP
NPI 1003206004
Nurse Practitioner - Psychiatric/Mental Health in Tustin, CA

Q: What is Michael Kelly's NPI number?

The NPI number for Michael Kelly is 1003206004. It was assigned to this individual provider in the NPPES registry on January 28, 2015.

Q: What is Michael Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Michael Kelly was last updated on January 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 28, 2015

17601 17TH ST STE 120, TUSTIN, CA 92780(714) 769-6090 Get Directions Write a Review

NPPES record last updated: January 24, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 24, 2019, Jun 11, 2018 (2 updates tracked since 2018).

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About Mr. Michael Sean Kelly Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. MICHAEL SEAN KELLY NP (NPI 1003206004) is an individual psychiatric/mental health provider in Tustin, California, licensed in California (95001913) and active in the NPI registry since January 2015. He maintains a secondary practice location in Costa Mesa.

NPPES Registry Identity

NPI1003206004

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameMR. MICHAEL SEAN KELLYCredential: NP

Location Address17601 17TH ST STE 120Tustin, CA 92780-1946

Mailing Address215 Santa Isabel AveCosta Mesa, CA 92627-1509 · (949) 722-7118 · Fax (949) 722-7119

Phone(714) 769-6090

Sole ProprietorNo

Enumeration DateJanuary 28, 2015

Last NPPES UpdateJanuary 24, 20192 updates tracked since enumeration

✔ NPI 1003206004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in CA · 95001913

17601 17TH ST STE 120, Tustin, CA 92780

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Secondary Practice Location 1

Location 1275 Victoria StCosta Mesa, CA 92627-1906 · Phone (949) 722-7118 · Fax (949) 722-7118

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROACTIVEHEALTHLLC

Clinic/Center

17601 17TH ST STE 120
TUSTIN, CA 92780

Orange County (657) 210-4547

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Kelly's NPI number?

The NPI number for Michael Kelly is 1003206004. It was assigned to this individual provider in the NPPES registry on January 28, 2015.

Where is Michael Kelly located?

Michael Kelly practices at 17601 17th St Ste 120, Tustin, CA 92780. The listed phone number is (714) 769-6090.

What is Michael Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Michael Kelly was last updated on January 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.