Kelly Nicole Hafers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

30 Hazel St
Bridgeport, CT 06604-7752

Phone

(203) 576-4880

NPI assigned

Apr 21, 2021

Last updated

Jul 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: khafers1667383@nychhc.direct-ci.com
• Direct secure messaging: kny9002@direct.nyp.org

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.

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  Medicare reassignment
• North Shore Hematology Oncology Associates PC

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  Medicare reassignment

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1104408061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 HAZEL ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066047752",
            "telephone_number": "203-576-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HAZEL ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066047752",
            "telephone_number": "203-576-4880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "48 Burma Rd",
            "address_purpose": "LOCATION",
            "city": "Wyckoff",
            "state": "NJ",
            "postal_code": "074813302",
            "country_code": "US",
            "telephone_number": "201-414-7303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAFERS",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna K Hackett
• Rachel Ann Hackett
• Gail F. Hackney, RDH
• James Michael Haddon, DNP, PMHNP-BC
• Marcela Haendler, LPC
• Maimoona B Haffees
• Andrea B Hagani, M.D.
• Jennifer M Hagberg, NP-C
• Pierre Hage, MD
• George Allen Hagman, LCSW

• Physician Assistant in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.

Verify at the official NPI Registry.