Lawrence B. Kelly, MD PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAWRENCE B. KELLY, MD PLLC

Practice address

4825 Maccorkle Ave SW Ste C
South Charleston, WV 25309-1365

Phone

(304) 343-1022

Fax

(304) 343-1025

NPI assigned

May 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lawrence Bennett Kelly, M.D.NPI 1629031901

Title

Owner

Phone

(304) 343-1022

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence Bennett Kelly, M.D.

  • Specialist
  • South Charleston, WV
  • NPI 1629031901
  Medicare reassignment NPD Authorized official
• Elizabeth M Earles, MA.MA.MSW

  • Mental Health Counselor
  • Charleston, WV
  • NPI 1972645059
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1295947844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11850",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253391850",
            "telephone_number": "304-343-1022",
            "fax_number": "304-343-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 MACCORKLE AVE SW STE C",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091365",
            "telephone_number": "304-343-1022",
            "fax_number": "304-343-1025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE B. KELLY, MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "BENNETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-343-1022",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011496",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001720795",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DN1230",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra M Latimer Clevenger, MS, ATC
• Megan Lattie
• Jenna Laudadio
• Emily Laverty
• Kimberly Law
• Brenda Lawrence
• Gina Lawrence
• Jenny Laxton
• Matthew T Layne, OTR/L
• Tarrin Layne

• Specialist in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.