Individual provider Active NPI

Kelly Shaffer Jenkins, PT

  • Physical Therapist
  • Nashville, NC
National Provider Identifier
1043330020
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2603 Issued in NC
Practice address
627 E Washington St
Nashville, NC 27856-1737
Phone
(252) 459-5565
NPI assigned
Mar 31, 2007
Last updated
Aug 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2603 NC Primary

Addresses

Primary practice location

627 E Washington St
Nashville, NC 27856-1737

Mailing address

3627 Spring Field Rd
Rocky Mount, NC 27804-8356
Phone (252) 443-2766

Other identifiers 2

IdentifierTypeStateIssuer
75289OtherBCBS
7201148MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071030000096 NC Practitioner - Physical Therapist in Private Practice 2062509672 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2603NCMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Physical Therapy Associates LLC CurrentSince Aug 1, 2014 Accepting new patients
Carolina Physical Therapy Associates LLC Physical Therapist CurrentSince Aug 1, 2014 Accepting new patients
Carolina Physical Therapy Associates LLC Current Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients
Wilson Orthopaedic Surgery & Neurology Center PA Past Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients
Northern Carolina Orthopaedics, PLLC Past Accepting new patients
Carolina Physical Therapy Associates LLC Past Accepting new patients

Locations

401 Attain St
Ste 121
Fuquay Varina, NC 27526
Phone (252) 443-0808

143 Nashville Commons Dr
Nashville, NC 27856
Phone (252) 459-5565

627 E Washington St
Nashville, NC 27856
Phone (252) 382-9604

Interoperability endpoints

  • Direct secure messaging: kelly.jenkins@bwc.eclinicaldirectplus.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1043330020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 SPRING FIELD RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278048356",
            "telephone_number": "252-443-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 E WASHINGTON ST",
            "city": "NASHVILLE",
            "state": "NC",
            "postal_code": "278561737",
            "telephone_number": "252-459-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "KELLY",
        "middle_name": "SHAFFER",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-31",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "2603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "75289",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7201148",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.