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KELLY ANNE WALLIS FNP-C
NPI 1790454130
Nurse Practitioner - Family in San Diego, CA

Active since September 09, 2021
3020 CHILDRENS WAY, SAN DIEGO, CA 92123(858) 966-8800 Get Directions Write a Review

NPPES record last updated: October 27, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 27, 2022, Sep 9, 2021 (2 updates tracked since 2021).

About Kelly Anne Wallis Fnp-c NPPES

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

KELLY ANNE WALLIS FNP-C (NPI 1790454130) is an individual family provider in San Diego, California, licensed in California (NP95021594) and active in the NPI registry since September 2021.

NPPES Registry Identity

NPI1790454130
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameKELLY ANNE WALLISCredential: FNP-C
Location Address3020 CHILDRENS WAYSan Diego, CA 92123-4223
Mailing Address3020 Childrens Way # Mc5003San Diego, CA 92123-4223 · (858) 309-6300
Phone(858) 966-8800
Sole ProprietorNo
Enumeration DateSeptember 9, 2021
Last NPPES UpdateOctober 27, 20222 updates tracked since enumeration
NPPES CertifiedOctober 27, 2022
✔ NPI 1790454130 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
Licenses✔ Licensed in CA · NP95021594✔ Licensed in NV · 838204
3020 CHILDRENS WAY, San Diego, CA 92123
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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.

DR. NATALIE E. ELLINGTON MD
Pathology (Pediatric Pathology)
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 966-5944
SHANNA MICHAEL MILLER-NABAS RDN
Physician Assistant
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 576-1700
DR. ADRIANA HERRERA TREMOULET M.D.
Pediatrics (Pediatric Infectious Diseases)
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 966-7785
LORI MCCURDY M.S., CCC-SLP
Speech-Language Pathologist
3020 CHILDRENS WAY, MC5010
SAN DIEGO, CA 92123
San Diego County (858) 968-5838
MS. ANN M SUMIDA-JOHNSON M.A..
Audiologist
3020 CHILDRENS WAY, MC 5010
SAN DIEGO, CA 92123
San Diego County (858) 966-5838
RICHARD JOHN NEWTON M.D.
Pediatrics
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 966-8036
DR. SHAHFAR KHAN M.D.
Pediatrics (Pediatric Emergency Medicine)
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 966-8800
CARLY BETH WELCH CPNP-AC
Nurse Practitioner (Pediatrics)
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
San Diego County (858) 966-8800

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 Kelly Wallis's NPI number?

The NPI number for Kelly Wallis is 1790454130. It was assigned to this individual provider in the NPPES registry on September 9, 2021.

Where is Kelly Wallis located?

Kelly Wallis practices at 3020 Childrens Way, San Diego, CA 92123. The listed phone number is (858) 966-8800.

What is Kelly Wallis's specialty?

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

When was this NPI record last updated?

The NPPES record for Kelly Wallis was last updated on October 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.