KELLY RACKHAM FNP-C
NPI 1801497284
Nurse Practitioner - Family in Vista, CA

Q: What is Kelly Rackham's NPI number?

The NPI number for Kelly Rackham is 1801497284. It was assigned to this individual provider in the NPPES registry on November 3, 2020.

Q: What is Kelly Rackham'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 Kelly Rackham was last updated on January 27, 2023. 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.

Active since November 03, 2020PECOS Enrolled

1000 VALE TERRACE DR, VISTA, CA 92084(844) 308-5003 Get Directions Write a Review

NPPES record last updated: January 27, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 27, 2023, Oct 10, 2022, Feb 25, 2021 and 3 more (6 updates tracked since 2020).

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About Kelly Rackham Fnp-c NPPES

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

KELLY RACKHAM FNP-C (NPI 1801497284) is an individual family provider in Vista, California, licensed in California (95015717) and active in the NPI registry since November 2020. He is enrolled in Medicare PECOS and maintains a secondary practice location in La Jolla.

NPPES Registry Identity

NPI1801497284

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY RACKHAMCredential: FNP-C

Location Address1000 VALE TERRACE DRVista, CA 92084-5218

Mailing Address1000 Vale Terrace DrVista, CA 92084-5218 · (760) 631-5000

Phone(844) 308-5003

Sole ProprietorNo

Enumeration DateNovember 3, 2020

Last NPPES UpdateJanuary 27, 20236 updates tracked since enumeration

NPPES CertifiedJanuary 27, 2023

✔ NPI 1801497284 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 · 95015717

1000 VALE TERRACE DR, Vista, CA 92084

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Secondary Practice Location 1

Location 19850 Genesee AveLA Jolla, CA 92037-1224 · Phone (858) 864-9800

Other Identifiers 1

Other95015717CA · State Bon

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Rackham Fnp-c 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 92084 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

$94.87 typical visit price

range $62.10 – $184.71

Typical copayment $23.71 (range $15.52 – $46.17)

Most-billed visit code 99203

Established Patient

$108.42 typical visit price

range $20.62 – $151.42

Typical copayment $27.10 (range $5.15 – $37.85)

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.

CHRISTINE DOUGHERTY LCSW

Social Worker (Clinical)