JACQUELINE MARY KELLY PNP
NPI 1811651052
Nurse Practitioner - Pediatrics in Danville, WV
About Jacqueline Mary Kelly Pnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELINE MARY KELLY PNP (NPI 1811651052) is an individual pediatrics provider in Danville, West Virginia, licensed in New York (381614) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jacqueline Mary Kelly Pnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Jacqueline Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Madison, WV 25130
- Reassigned Medicare billing, West Virginia enrollment
- 159 clinicians in this Medicare group
Syracuse, NY 13210
- Reassigned Medicare billing, New York enrollment
- 271 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 25053 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
DANVILLE, WV 25053
DANVILLE, WV 25053
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 Jacqueline Kelly's NPI number?
The NPI number for Jacqueline Kelly is 1811651052. It was assigned to this individual provider in the NPPES registry on October 25, 2021.
Where is Jacqueline Kelly located?
Jacqueline Kelly practices at 300 4th St, Danville, WV 25053. The listed phone number is (304) 369-1230.
What is Jacqueline Kelly's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Jacqueline Kelly enrolled in Medicare?
Yes. Jacqueline Kelly is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jacqueline Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Kelly reassigns Medicare benefits to 2 organizations: Boone Memorial Hospital, Inc (Madison, WV) and Suny Health Science Center At Syracuse (Syracuse, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqueline Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jacqueline Kelly was last updated on July 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Jacqueline Mary Kelly, PNP · NPI 1811651052
Pediatrics physician in Danville, West Virginia. Individual provider, active in the CMS NPPES registry since October 25, 2021.
## Identity
- **NPI:** 1811651052 (Entity type: Individual)
- **Enumerated:** October 25, 2021
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 381614 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 300 4TH ST, Danville, WV 25053-4632
- **Phone:** (304) 369-1230
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Boone Memorial Hospital, Inc (NPI 1801039565, Madison, WV); Suny Health Science Center At Syracuse (NPI 1184974529, Syracuse, NY) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 29, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1811651052) · Data from the CMS NPPES public registry.