Active NPI
Kelsey Nutt Peters, DDS
- Dentist
- Mobile, AL
National Provider Identifier
1073033296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6426
- Practice address
- 7760 Moffett Rd
Mobile, AL 36618-4136 - Phone
- (251) 649-1333
- NPI assigned
- Jun 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6426 | AL | Primary |
Addresses
Primary practice location
7760 Moffett Rd
Mobile, AL 36618-4136
Mailing address
1569 Vassar CT
Mobile, AL 36695-6112
Phone (870) 313-1322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171228002029 | AL | Order and Referring Only - Dentist | 9638437445 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6426 | AL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510704000000",
"number": "1073033296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1569 VASSAR CT",
"city": "MOBILE",
"state": "AL",
"postal_code": "366956112",
"telephone_number": "870-313-1322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7760 MOFFETT RD",
"city": "MOBILE",
"state": "AL",
"postal_code": "366184136",
"telephone_number": "251-649-1333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "KELSEY",
"middle_name": "NUTT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-20",
"last_updated": "2017-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "6426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.