Kennitrish Nickola Bracey, DNP, APRN, AGNP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

5014047 Issued in NC

Practice address

1131 N Church St
Greensboro, NC 27401-1015

Phone

(972) 881-4688

NPI assigned

Oct 17, 2020

Last updated

Dec 6, 2023By the provider in NPPES

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 NC

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Horizon Internal Medicine PLLC

  • Internal Medicine Physician
  • High Point, NC
  • NPI 1033353941
  Medicare reassignment NPD
• Kinetic Medical Group

  • Family Nurse Practitioner
  • Potomac, MD
  • NPI 1285228585

  NC

  Medicare reassignment NPD
• Physiatry Consultants of NC PLLC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1437736881

  NC

  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  NC, Nurse Practitioner

  Medicare reassignment NPD
• Legacy Physiatry Group North Carolina

  dba Legacy Physiatry Group NC

  • Physical Medicine & Rehabilitation Physician
  • Wilson, NC
  • NPI 1841967064
  NPD (past)
• NC Elder Care PLLC

  • Internal Medicine Physician
  • High Point, NC
  • NPI 1962948240
  NPD (past)
• Theoria Medical

  dba Theoria Primary Care

  • Internal Medicine Physician
  • Brighton, MI
  • NPI 1164186946

  Nurse Practitioner

  NPD (past)

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

{
    "created_epoch": "1602892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1295334647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 N CHURCH ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011015",
            "telephone_number": "336-456-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 N CHURCH ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011015",
            "telephone_number": "972-881-4688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Sharing Ter",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274058670",
            "country_code": "US",
            "telephone_number": "133-645-6042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACEY",
        "first_name": "KENNITRISH",
        "middle_name": "NICKOLA",
        "credential": "DNP, APRN, AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-17",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "5014047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marsheta Andrea' Boyton
• Michelle Bennett Bozovich, PHARMD
• Phillip E Bozovich, PHARMD
• Conrad Donald Braaten, DO
• Vance Wells Brabham IV, M.D.
• Thomas Andrew Brackbill, M.D.
• Alisha Nicole Bracken, CRNA
• Angela Chyrisse Kaiulani Bracken, PA-C
• Lisa Eileen Bracken, LCSW
• Clark Kennard Brackney, DPM

• Primary Care Nurse Practitioner in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Primary Care Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.