Individual provider Active NPI

Latifah Nelson, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1114514882
Registry record updated Oct 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP023488 Issued in PA
Practice address
6501 Harbison Ave
Philadelphia, PA 19149-2912
Phone
(215) 333-4300
NPI assigned
Dec 28, 2020
Last updated
Oct 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP023488 PA Primary

Addresses

Primary practice location

6501 Harbison Ave
Philadelphia, PA 19149-2912

Mailing address

6501 Harbison Ave
Philadelphia, PA 19149-2912
Phone (215) 333-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20211214000524 PA Practitioner - Nurse Practitioner 2567852197 Reassigns benefits to 1 organization
I20230901000019 NJ Practitioner - Nurse Practitioner 2567852197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

18 E Laurel Rd
Stratford, NJ 08084-1327
Phone (856) 513-4124

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP023488PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice, P.C. CurrentSince May 20, 2023 Accepting new patients
Aria Health Physician Services Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Aria Health Physician Services Family Medicine Current Accepting new patients
Aria Health Physician Services CurrentSince Aug 1, 2022 Accepting new patients
Kennedy Medical Group Practice, P.C. Family Medicine CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC Family Medicine CurrentSince May 20, 2023 Accepting new patients
Kennedy Medical Group Practice P.C. Family Medicine Past Accepting new patients

Locations

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

18 E Laurel Rd
Stratford, NJ 08084
Phone (856) 346-6000

10800 Knights Rd
Philadelphia, PA 19114
Phone (215) 612-2610

1101 Market St
Fl 19
Philadelphia, PA 19107
Phone (215) 481-6836

3998 Red Lion Rd
Ste 235
Philadelphia, PA 19114
Phone (215) 632-3630

5000 Frankford Ave
Ste 1B
Philadelphia, PA 19124
Phone (215) 583-2355

Organizations & group practices 7

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633824000000",
    "number": "1114514882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 HARBISON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492912",
            "telephone_number": "215-333-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 HARBISON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492912",
            "telephone_number": "215-333-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "LATIFAH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-28",
        "last_updated": "2021-10-10",
        "certification_date": "2021-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP023488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.