Active NPI
Andrea W Kelly, RN, BSN
- Registered Nurse
- Wadesboro, NC
National Provider Identifier
1104135979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 111797
- Practice address
- 704 Old Lilesville Road
Wadesboro, NC 28170-2820 - Phone
- (704) 694-6588
- NPI assigned
- Sep 28, 2010
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 111797 | NC | Primary |
Addresses
Primary practice location
704 Old Lilesville Road
Wadesboro, NC 28170-2820
Mailing address
284 Executive Park Dr
Suite 100
Concord, NC 28025-1894
Phone (704) 939-1118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111797 | NC | MD | Registered Nurse |
Interoperability endpoints
- andrea.kelly.p1@direct.daymarkrecovery.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1104135979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "284 EXECUTIVE PARK DR",
"address_2": "SUITE 100",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251894",
"telephone_number": "704-939-1118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 OLD LILESVILLE ROAD",
"city": "WADESBORO",
"state": "NC",
"postal_code": "281702820",
"telephone_number": "704-694-6588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ANDREA",
"middle_name": "W",
"credential": "RN, BSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-28",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NC",
"license": "111797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wadesboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.