Healthcare Provider Details

I. General information

NPI: 1356928568
Provider Name (Legal Business Name): MEGHAN ROSE KELLY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 JAMBOREE RD
NEWPORT BEACH CA
92660-2526
US

IV. Provider business mailing address

4699 JAMBOREE RD
NEWPORT BEACH CA
92660-2526
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-3713
  • Fax: 949-764-5262
Mailing address:
  • Phone: 949-764-3713
  • Fax: 949-764-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: