JACQUELINE KELLY
NPI 1235077694
Nurse Practitioner - Family in Lakeport, CA

Q: What is Jacqueline Kelly's NPI number?

The NPI number for Jacqueline Kelly is 1235077694. It was assigned to this individual provider in the NPPES registry on March 24, 2026.

Q: What is Jacqueline Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Jacqueline Kelly was last updated on March 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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 March 24, 2026PECOS Enrolled

925 BEVINS CT, LAKEPORT, CA 95453(707) 263-8382 Get Directions Write a Review

NPPES record last updated: March 24, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

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About Jacqueline Kelly NPPES

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

JACQUELINE KELLY (NPI 1235077694) is an individual family provider in Lakeport, California, licensed in California (F02260054) and active in the NPI registry since March 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1235077694

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJACQUELINE KELLY

Location Address925 BEVINS CTLakeport, CA 95453-9754

Mailing AddressPo Box 516Clearlake Oaks, CA 95423-0516 · (916) 613-0098

Phone(707) 263-8382

Sole ProprietorNo

Enumeration DateMarch 24, 2026

NPPES CertifiedMarch 24, 2026

✔ NPI 1235077694 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · F02260054

925 BEVINS CT, Lakeport, CA 95453

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Kelly is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95453 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$103.36 typical visit price

range $19.28 – $144.60

Typical copayment $25.84 (range $4.82 – $36.15)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

MERRILL FEATHERSTONE MFC

Counselor (Mental Health)