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NPI profile

KELLY ETZEL

NPI record status, taxonomy, official source timestamp, and OIG LEIE screening context.

NPI record foundexcludedNPI API source

Identity

NPI
1639285281
Entity type
NPI-1
Primary taxonomy
363A00000X
NPI source updated
Jul 08, 2007
Enumeration date
Aug 23, 2006
Cache fetched
May 05, 2026

NPI does not validate licensure, credentialing, Medicare enrollment, or current practice authority.

OIG LEIE screening

excludedConfidence: high

Exact OIG exclusion match by NPI.

KELLY ETZELExact OIG exclusion match by NPI.

NPI addresses

NPI addresses from the official registry record
PurposeAddressPhone
MAILING4067284100
LOCATION4067284100
Screen a CSVNPI and OIG data notes

FAQ

Practical notes

Does an NPI record validate licensure?

No. NPI data does not validate licensure, credentialing, Medicare enrollment, or current practice authority.