Kelly Marie Wong, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP4100 Issued in AZ

Practice address

861 SW 78TH Ave
Ste 200B
Plantation, FL 33324-3273

Phone

(877) 693-5700

NPI assigned

Aug 29, 2011

Last updated

Jun 20, 2023By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advanced Spine and Pain LLCGroup PAC ID 0941610075, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.wong@asapl-az.direct.office.nextgen.com

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.

• Advanced Spine and Pain LLC

  • Interventional Pain Medicine Physician
  • Phoenix, AZ
  • NPI 1356950653

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Comprehensive Hospitalist Services of Arizona LLC

  • Hospitalist Physician
  • Mesa, AZ
  • NPI 1689909780
  Medicare reassignment NPD
• Advanced Spine and Pain LLC

  • Pain Medicine (Anesthesiology) Physician
  • Phoenix, AZ
  • NPI 1639951577
  NPD
• Comprehensive Hospitalist Services of Arizona, LLC

  • Hospitalist Physician
  • Bullhead City, AZ
  • NPI 1265823215

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1174803605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6553 E BAYWOOD AVE STE 201",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061754",
            "telephone_number": "480-467-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 SW 78TH AVE",
            "address_2": "STE 200B",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243273",
            "telephone_number": "877-693-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-29",
        "last_updated": "2023-06-20",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP4100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.wong@envisionhealth.com",
            "affiliation": "N",
            "address_1": "6553 E Baywood Ave",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852061752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Jay Wolland, NP-C
• James C Wolper, MD
• Albert G Wong, D.M.D.
• Juan Wong, DMD
• Juliet Wong, SLP
• Marcial Johnny Wong
• Donna German Wood
• Clive Woods, MD
• Alyssa Woolslair, LMHC
• World Wide Pediatrics, LLC

• Nurse Practitioner in Plantation, FL
• Providers in Plantation, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.