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General NPI Number Information
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NPI Number | 1013769561
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Entity Type | Individual
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Provider Name | KELSIE NOELLE KEGLEY
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Gender | Female
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 9 TECHNOLOGY DR
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City | IRVINE
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State | CA
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Zip | 92618-2302
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Country | US
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Telephone | 949-923-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 95086214
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95028813
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License Number State | CA
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