Active NPI
Kellie Preslar Koontz, NP
- Nurse Practitioner
- Winston Salem, NC
National Provider Identifier
1255989943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5012173
- Practice address
- 1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101-3006 - Phone
- (336) 713-9800
- Fax
- (336) 713-9641
- NPI assigned
- Aug 27, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5012173 | NC | Primary |
Addresses
Primary practice location
1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101-3006
Mailing address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 713-9800
Other practice location 1
245 Charlois Blvd
Winston Salem, NC 27103-1507
Phone (336) 659-4777
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kkoontz143053@direct.novanthealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5012173 | NC | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Current | Accepting new patients |
Locations
Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697
1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101
Phone (336) 713-9800
Interoperability endpoints
- kkoontz2753597@carolinashealthcaresystem.direct-ci.com
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Winston Salem, NC
- NPI 1003803032
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Winston Salem, NC
- NPI 1063480531
-
- Rehabilitation Hospital Unit
- Winston Salem, NC
- NPI 1114995677
-
dba Wake Forest Baptist Medical Center
- General Acute Care Hospital
- Winston Salem, NC
- NPI 1144211301
-
dba Wake Forest Baptist Medical Center
- Clinical Medical Laboratory
- Winston Salem, NC
- NPI 1609162098
Hospital
-
dba Winston East Pediatrics
- Pediatric Adolescent Medicine Physician
- Winston Salem, NC
- NPI 1912179219
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1255989943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-713-9800",
"fax_number": "336-713-9641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N MARTIN LUTHER KING JR DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271013006",
"telephone_number": "336-713-9800",
"fax_number": "336-713-9641"
}
],
"practiceLocations": [
{
"address_1": "245 Charlois Blvd",
"address_purpose": "LOCATION",
"city": "Winston Salem",
"state": "NC",
"postal_code": "271031507",
"country_code": "US",
"telephone_number": "336-659-4777",
"fax_number": "336-659-4798",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOONTZ",
"first_name": "KELLIE",
"middle_name": "PRESLAR",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-27",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NC",
"license": "5012173",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kkoontz143053@direct.novanthealth.org",
"affiliation": "N",
"address_1": "245 Charlois Blvd",
"city": "Winston Salem",
"state": "NC",
"country_code": "US",
"postal_code": "271031507",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.