Kelly Stevens, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-11495 Issued in NC

Practice address

2635 Lawndale Dr
Greensboro, NC 27408-4802

Phone

(336) 867-4310

NPI assigned

Sep 19, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Kelly Stevens-Pico Former name

Medicare fee-for-service enrollment

Enrolled in FL, MT, GA, VT, NC5 enrollments

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 5

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kstevens1632892@direct.novanthealth.org
• Direct secure messaging: kstevens576885@direct.uvmhealth.org

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

• Central Vermont Medical Center Inc

  • Family Medicine Physician
  • Berlin, VT
  • NPI 1023028784
  Medicare reassignment NPD
• Porter Hospital Inc

  • Critical Access Hospital
  • Middlebury, VT
  • NPI 1740291400
  Medicare reassignment NPD
• Wheatland Memorial Healthcare

  • Rural Health Clinic/Center
  • Harlowton, MT
  • NPI 1235204538
  Medicare reassignment NPD
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment
• Adventist Health System Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • Maitland, FL
  • NPI 1073565610
  Medicare reassignment
• Bluewater Emergency Partners of Brunswick, LLC

  • Emergency Medicine Physician
  • Brunswick, ME
  • NPI 1043640204

  VT

  Medicare reassignment
• Global Physician Network LLC Series II

  • Emergency Medicine Physician
  • Sarasota, FL
  • NPI 1821518028
  Medicare reassignment
• North Fulton Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Roswell, GA
  • NPI 1053456954
  Medicare reassignment
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment
• Small Hospital Innovations LLC

  • Emergency Medicine Physician
  • Clewiston, FL
  • NPI 1184040560

  GA

  Medicare reassignment
• Townsend Health Systems, Inc.

  • Critical Access Hospital
  • Townsend, MT
  • NPI 1447245857
  Medicare reassignment
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1104811959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601843",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601843",
            "telephone_number": "406-322-1000",
            "fax_number": "406-322-5207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 LAWNDALE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274084802",
            "telephone_number": "336-867-4310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 11th St N",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MT",
            "postal_code": "590197215",
            "country_code": "US",
            "telephone_number": "406-322-1000",
            "fax_number": "406-322-5207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KELLY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031677",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "41208",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA3513",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291575800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "STEVENS-PICO",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven L Hatcher DDS PA
• Steven M Daniels Jr PHD PLLC
• Steven S Gold, D.D.S., P.a.
• Steven W. Bernstorf, OD, PA
• Briana Nicole Stevens, MD
• Susan Welch Stevens, EDD, ATC, LAT
• William Ross Stevens, M.D.
• Amy R Stevenson, D.O.
• Casaun Stevenson
• Jasia Stevenson

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.