Kelly Jo Hazuka, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

58344 Issued in WV

Practice address

100 Avery Olivia Way Ste B
Fairmont, WV 26554-9375

Phone

(304) 333-1650

Fax

(304) 333-1651

NPI assigned

Oct 14, 2012

Sex

Female

Sole proprietor

No

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 WV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Exemplar, Inc

  • Specialist
  • Bridgeport, WV
  • NPI 1396845236
  Medicare reassignment NPD
• Community Care of West Virginia, Inc.

  dba Pocahontas County High School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Dunmore, WV
  • NPI 1043567456
  NPD
• Community Care of West Virginia, Inc.

  dba Little Birch Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Sutton, WV
  • NPI 1053821363
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care Connections of Buckhannon

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1063048189
  NPD
• Community Care of West Virginia, Inc.

  dba Roanoke Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Roanoke, WV
  • NPI 1104292168
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care of Bridgeport

  • Community/Behavioral Health Agency
  • Bridgeport, WV
  • NPI 1144811290
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care of Green Bank

  • Federally Qualified Health Center (FQHC)
  • Green Bank, WV
  • NPI 1164557237
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care of Marlinton

  • Federally Qualified Health Center (FQHC)
  • Marlinton, WV
  • NPI 1164653457
  NPD
• Community Care of West Virginia, Inc.

  dba Mountaineer Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Clarksburg, WV
  • NPI 1164809802
  NPD
• Community Care of West Virginia, Inc.

  dba Rock Cave Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Rock Cave, WV
  • NPI 1194191676
  NPD
• Community Care of West Virginia, Inc.

  dba Upshur County PALS Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1194339309
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care Pediatrics of Buckhannon

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1255507810
  NPD

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

{
    "created_epoch": "1350172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507161600000",
    "number": "1205188240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 AVERY OLIVIA WAY STE C",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265549375",
            "telephone_number": "304-363-7000",
            "fax_number": "304-366-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 AVERY OLIVIA WAY STE B",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265549375",
            "telephone_number": "304-333-1650",
            "fax_number": "304-333-1651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Grand Central Ave",
            "address_2": "Suite 115",
            "address_purpose": "LOCATION",
            "city": "Vienna",
            "state": "WV",
            "postal_code": "261051079",
            "country_code": "US",
            "telephone_number": "304-489-3815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZUKA",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-14",
        "last_updated": "2017-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "58344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Hayes
• Willie Hayes
• Ian Hayhurst
• Karri Hayhurst, BSN, RN, NCSN
• Ryan Michael Hayhurst, PHARMD
• Healing Grove Psychological Services, LLC
• Desiree Lynn Heater
• Heather McDonnell-Stalnaker, LPC, LLC
• Melyssa Ellen Hedrick
• Amanda Heflin

• Family Nurse Practitioner in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.