Individual provider Active NPI

Denise Kerby, CNP

  • Gerontology Nurse Practitioner
  • Port Royal, SC
National Provider Identifier
1174073852
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
27272 Issued in SC
Practice address
1810 Richmond Ave
Port Royal, SC 29935-2015
Phone
(843) 781-7700
NPI assigned
Oct 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 27272 SC
Adult Health Nurse Practitioner 363LA2200X CNP 019825 OH
Gerontology Nurse Practitioner 363LG0600X 27272 SC Primary

Addresses

Primary practice location

1810 Richmond Ave
Port Royal, SC 29935-2015

Mailing address

545 Farr Ave
Wadsworth, OH 44281-2322

Other identifiers 1

IdentifierTypeStateIssuer
0205006MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20230516003717 SC Practitioner - Nurse Practitioner 8325321219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Response Nurse Practitioners, LLCGroup PAC ID 8527349992, 9 clinicians

Practice addresses (Care Compare)

60 Okatie Village Dr
Okatie, SC 29909-6554
Phone (843) 548-2500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CNP 019825OHMDAdult Health Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1174073852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 FARR AVE",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442812322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 RICHMOND AVE",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299352015",
            "telephone_number": "843-781-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERBY",
        "first_name": "DENISE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-06",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "27272",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "CNP 019825",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "SC",
            "license": "27272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0205006",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Royal, SC

Sources for this page

Verify at the official NPI Registry.