Marie Krider Lively, PNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5015657 Issued in NC

Practice address

635 N NC 16 Business Hwy
Denver, NC 28037-7574

Phone

(704) 489-8401

NPI assigned

Jan 25, 2022

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

Other names 1

• Marie Nicole Krider Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Lakeshore Pediatric Center, P.a.

  • Pediatrics Physician
  • Denver, NC
  • NPI 1366650707
  NPD (past)
• Peachtree Park Pediatrics, LLP

  • Pediatrics Physician
  • Atlanta, GA
  • NPI 1699835660
  NPD (past)

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1245982891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 WINDSOR DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093349",
            "telephone_number": "804-212-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 N NC 16 BUSINESS HWY",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280377574",
            "telephone_number": "704-489-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVELY",
        "first_name": "MARIE",
        "middle_name": "KRIDER",
        "credential": "PNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5015657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "KRIDER",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lincoln Charter School
• Karle Linden
• Stefany Linden
• Chelsea Lineberger, PT
• Kevin Patrick Lingle, DMD
• Gregory Logan, LCMHC
• Amanda Lopez, RN
• Jeffrey Richard Many, M.D.
• Marigold Moon Counseling, PLLC
• Marsocci Family, PLLC

• Pediatric Nurse Practitioner in Denver, NC
• Providers in Denver, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.