Kellie Faye Gautier, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Daniels, WV
NPI 1215219902 · NPPES record last updated Jul 17, 2024
Key facts
- NPI
- 1215219902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 73240 (WV)
- Practice address
- 1468 Ritter Dr
Daniels, WV 25832-9356 - Phone
- (304) 253-3860
- NPI assigned
- Sep 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- West Virginia University School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prompt Care Inc
Practice addresses (Care Compare)
1468 Ritter Dr
Daniels, WV 25832-9356
Phone (304) 253-3860
Hospital & facility affiliations
- Raleigh General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in WV, FL, PA, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111130000547 | WV | Practitioner - Nurse Practitioner | 5597939595 | Reassigns benefits to 1 organization |
| I20220725002198 | FL | Practitioner - Nurse Practitioner | 5597939595 | Reassigns benefits to 2 organizations |
| I20240131004152 | PA | Practitioner - Nurse Practitioner | 5597939595 | Reassigns benefits to 1 organization |
| I20240313000029 | VA | Practitioner - Nurse Practitioner | 5597939595 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73240 | WV | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medexpress Urgent Care, PC - Pennsylvania | Current |
Accepting new patients | |
| Medexpress Urgent Care, PC - Virginia | Current |
Accepting new patients | |
| Dwic of Tampa Bay, Inc. | Current | Accepting new patients | |
| Medexpress Urgent Care, PC - Virginia | Current |
Accepting new patients | |
| Dwic of Tampa Bay, Inc. | Current |
Accepting new patients | |
| Prompt Care, Inc. | Current |
Accepting new patients | |
| Urgent Care, PC - Pennsylvania | Current | Accepting new patients | |
| Dwic of Tampa Bay, Inc. | Current |
Accepting new patients | |
| Medexpress Urgent Care of Boynton Beach, LLC | Current |
Accepting new patients | |
| Medexpress Urgent Care of Boynton Beach, LLC | Current |
Accepting new patients | |
| Medexpress Urgent Care, PC - Pennsylvania | Current |
Accepting new patients | |
| Beckley Vascular Associates PLLC | Past |
Accepting new patients | |
| CM Oneal MD Inc | Past | Accepting new patients | |
| Chipley Chiropractic | Past |
Accepting new patients | |
| Integrative Womens Care PC | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients | |
| Dwic of Tampa Bay, Inc | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
7593 Boynton Beach Blvd
Ste 190
Boynton Beach, FL 33437
Phone (561) 572-3200
8849 State Road 52
Hudson, FL 34667
Phone (727) 863-7150
1120 Homestead Rd N
Lehigh Acres, FL 33936
Phone (239) 303-5020
2810 W Mlk Blvd
Tampa, FL 33607
Phone (813) 289-6637
4808 Edgmont Ave
Brookhaven, PA 19015
Phone (610) 876-3072
7219 McKnight Rd
Ste F
Pittsburgh, PA 15237
Phone (412) 367-3278
1336 W Main St
Salem, VA 24153
Phone (540) 389-0374
1468 Ritter Dr
Daniels, WV 25832
Phone (304) 253-2860
423 Fortress Blvd
Morgantown, WV 26508
Phone (844) 852-9510
Interoperability endpoints
- kellie.gautier.1@27069.direct.athenahealth.com
- kgautier38172@direct.optum.com
- kellie.gautier.1@32403.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 73240 | WV | Yes |
Addresses
Primary practice location
1468 Ritter Dr
Daniels, WV 25832-9356
Mailing address
330 Cedarcrest Dr
Shady Spring, WV 25918-8541
Phone (304) 890-8987
Other practice location 1
1000 N West St Ste 1200
Wilmington, DE 19801-1058
Phone (888) 731-8994
Other practice location 2
445 S Figueroa St Fl 31
Los Angeles, CA 90071-1602
Phone (888) 731-8994
Other practice location 3
111 N Orange Ave Ste 800
Orlando, FL 32801-2381
Phone (888) 731-8994
Other practice location 4
201 N Illinois St Fl 16
Indianapolis, IN 46204-1904
Phone (888) 731-8994
Other practice location 5
100 Cambridge St Fl 14
Boston, MA 02114-2509
Phone (888) 731-8994
Other practice location 6
10440 Little Patuxent Pkwy Ste 300
Columbia, MD 21044-3648
Phone (888) 731-8994
Other practice location 7
700 Main St Ste 3
Bangor, ME 04401-6800
Phone (888) 731-8994
Other practice location 8
400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599
Phone (888) 731-8994
Other practice location 9
20 Foundry St Fl 2
Concord, NH 03301-5419
Phone (888) 731-8994
Other practice location 10
429 4th Ave Fl 7
Pittsburgh, PA 15219-1500
Phone (888) 731-8994
Other practice location 11
232 Capitol St Ste 18
Charleston, WV 25301-2234
Phone (888) 731-8994
Other practice location 12
1101 Wilson Blvd Fl 6
Arlington, VA 22209-2281
Phone (888) 731-8994
Other practice location 13
10 Dorrance St Ste 700
Providence, RI 02903-2014
Phone (888) 731-8994
Other practice location 14
1 Lawson Ln Ste 200D
Burlington, VT 05401-8445
Phone (888) 731-8994
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810021842 | Medicaid | WV |
Other providers in Daniels, WV
- Rodney L Fink
- James Timothy Foster
- Tiffany Francis
- Sara Frost
- James C Garvin
- Matthew Lindsey Goodwin
- Steven Gray
- James Carl Gwinn
- Zachary Tyler Halsey
- Angela Dawn Harold
All providers in Daniels, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.