Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Anne Wallis, FNP-C

Individual provider Family Nurse Practitioner · NPI 1790454130

Kelly Anne Wallis, FNP-C is a Family Nurse Practitioner in San Diego, California. Licensed in California and Nevada. Registered with an NPI since 2021.

Licensed in
CA, NV
In the registry since
2021
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

3020 Childrens Way
San Diego, CA 92123-4223
Phone: (858) 966-8800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence NP95021594 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 838204 (NV)

Record details

NPI number1790454130
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedSeptember 9, 2021
Last updated in NPPESOctober 27, 2022
Certification dateOctober 27, 2022

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