JACQUELINE KELLY (NPI# 1104169283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104169283 |
| Entity Type | Individual |
| Full Name | JACQUELINE KELLY |
| Credential | M.D. |
| Practice Address |
500 West Fort St. #111 Boise Vamc Boise ID 83702 |
| Practice Telephone | 2084221314 |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-07-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MRM-1350 | ID | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669432498 | Jacqueline F Kelly | Legal Medicine | 1428 S Osprey Ave, Sarasota, FL 34239-2914 | 2006-03-24 |
| 1699774505 | Jacqueline Kelly | General Practice | 300 E 8th St, G-159, Austin, TX 78701-3233 | 2005-07-21 |
| 1558855296 | Jacqueline Kelly | Nurse Practitioner | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2018-06-17 |
| 1730507971 | Jacqueline Kelly | Radiology | 20 York St, Ynhh Department of Therapeutic Radiology, New Haven, CT 06510-3220 | 2014-04-04 |
| 1710293436 | Jacqueline Kelly | Marriage & Family Therapist | 220 George W Liles Pkwy Nw, Concord, NC 28027-6531 | 2010-08-19 |
| 1124109624 | Jacqueline Kelly | Nurse Practitioner | 400 Gresham Dr, Suite 303, Norfolk, VA 23507-1901 | 2006-10-18 |
| 1235231630 | Jacqueline Kelly | Pediatrics | 269 Peninsula Farm Rd, Suite F, Arnold, MD 21012-1013 | 2006-09-05 |
| Street Address |
500 WEST FORT ST. #111 BOISE VAMC |
| City | BOISE |
| State | ID |
| Zip Code | 83702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164832374 | Diana Swett | Student in an Organized Health Care Education/Training Program | 500 West Fort St. #111, Boise Vamc, Boise, ID 83702 | 2014-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891256004 | Ryan Thompson | Internal Medicine | 400 W Fort St # 111r, Boise, ID 83702-4531 | 2019-03-29 |
| 1518311679 | Samantha Hersrud | Internal Medicine | 500 W Fort St 111r, Internal Medicine Residency, Boise, ID 83702 | 2016-04-14 |
| 1649634718 | Elizabeth Ann Schackmann | Internal Medicine | 500 W Fort St # 111r, Boise, ID 83702-4501 | 2016-04-05 |
| 1134513088 | Alex Tanabe | Internal Medicine | 1000 E Park Blvd, Boise, ID 83712-7791 | 2015-03-27 |
| 1083980734 | Shanaz Sikder | Internal Medicine | 403 S 11th St Ste 100, Boise, ID 83702 | 2012-03-27 |
| 1679869473 | Allyson J Komori | Internal Medicine | 500 W Fort St # 111, Suite 202, Boise, ID 83702-4501 | 2011-06-21 |
| 1982929048 | Sarita Anisha Kishore | Internal Medicine | 1970 Toluka Way, Boise, ID 83712-8547 | 2010-04-01 |
| 1568796282 | Life Quest Center Inc | Internal Medicine | 3355 N Five Mile Rd, Ste 284, Boise, ID 83713-3925 | 2009-09-28 |
| 1164673968 | Jenifer L Barry | Internal Medicine | 1525 S Owyhee St, Boise, ID 83705-6014 | 2008-10-10 |
| 1275722704 | Allan M Salzberg | Internal Medicine | 10671 Sandpiper St, Boise, ID 83709-1249 | 2007-10-22 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.