Kelley Marie Moody, NP-C

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

23682 Issued in SC

Practice address

750 W Carolina Ave
Hartsville, SC 29550-4412

Phone

(843) 951-9990

Fax

(843) 951-9989

NPI assigned

Feb 17, 2020

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 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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carolina Pines Regional Medical Center Hospital, Hartsville, SC, CCN 420010

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Compassionate Care of Hartsville

  • Clinic/Center
  • Hartsville, SC
  • NPI 1063173458
  Medicare reassignment NPD Authorized official

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

• Hartsville, LLC

  • General Acute Care Hospital
  • Hartsville, SC
  • NPI 1174500458
  Care Compare affiliation

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1194358317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 W CAROLINA AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504412",
            "telephone_number": "843-995-9990",
            "fax_number": "843-951-9989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 W CAROLINA AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504412",
            "telephone_number": "843-951-9990",
            "fax_number": "843-951-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "KELLEY",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "SC",
            "license": "23682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Vanco Mincheff, MD
• Edwin Kyle Mitchell, O.D.
• Gyetri Mitchell, MSN, FNP
• Tiffany Coward Mixon, LPC
• Aseanda Leane Moody, MA
• Casey Miller Moore, CPNP
• Delores Moore, D.AC., PH.D.
• Kaitlyn Moore, CCC-SLP
• Raymond Everett Moore, R.PH
• Toni Garner Moore, PHARMACIST

• Adult Medicine Physician in Hartsville, SC
• Providers in Hartsville, SC by specialty
• Adult Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.