KELLY J WALLIN
NPI 1447575709
Student in an Organized Health Care Education/Training Program in Sacramento, CA

Q: What is Kelly Wallin's NPI number?

The NPI number for Kelly Wallin is 1447575709. It was assigned to this individual provider in the NPPES registry on March 30, 2010.

Q: What is Kelly Wallin's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Wallin was last updated on December 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 March 30, 2010PECOS EnrolledAccepts Medicare Assignment

2025 MORSE AVE, SACRAMENTO, CA 95825(916) 973-6961 Get Directions Write a Review

NPPES record last updated: December 15, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Kelly J Wallin NPPES

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

KELLY J WALLIN (NPI 1447575709) is an individual student in an organized health care education/training program in Sacramento, California and active in the NPI registry since March 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2010).

NPPES Registry Identity

NPI1447575709

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameKELLY J WALLIN

Location Address2025 MORSE AVESacramento, CA 95825-2115

Mailing Address1890 Geneva PlSacramento, CA 95825-1315

Phone(916) 973-6961

Sole ProprietorNo

Medical School CMSOtherGraduated 2010

Enumeration DateMarch 30, 2010

Last NPPES UpdateDecember 15, 2021

✔ NPI 1447575709 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2025 MORSE AVE, Sacramento, CA 95825

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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 and accepts Medicare assignment

Kelly J Wallin is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6103051891

PECOS Enrollment IDI20131105001845

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.

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.

SHARON KAY MCCOY FNP

Nurse Practitioner (Family)