Mr. Michael Sean Kelly
Nurse Practitioner - Psychiatric/Mental Health
17601 17th St Ste 120
Tustin
, California 92780-1946
Mr. Michael Sean Kelly
Nurse Practitioner - Psychiatric/Mental Health
17601 17th St Ste 120
Tustin
, California 92780-1946
(949) 722-7119
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About
Features
Specialties
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Mr. Michael Sean Kelly
- 215 Santa Isabel Ave
- Costa Mesa, CA
- Zip : 92627-1509
- Fax : (949) 722-7119
- Phone : (949) 722-7118
Second Address
- Mr. Michael Sean Kelly
- 17601 17th St Ste 120
- Tustin, CA
- Zip : 92780-1946
- Phone : (714) 769-6090
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95001913 | CA |
National Provider Identifier
| NPI | 1003206004 |
|---|---|
| Provider Name | Mr. Michael Sean Kelly |
| First Address | Costa Mesa, CA 92627-1509 |
| Second Address | Tustin, CA 92780-1946 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/01/2015 |
| Last Update Date | 24/01/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.