Individual provider Active NPI

Keely Radcliff Paramo

  • Women's Health Nurse Practitioner
  • Moultrie, GA
National Provider Identifier
1306663455
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
RN176734 Issued in GA
Practice address
115 31St Ave SE
Moultrie, GA 31768-6771
Phone
(229) 502-7988
Fax
(229) 890-2166
NPI assigned
Sep 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X RN176734 GA Primary

Addresses

Primary practice location

115 31St Ave SE
Moultrie, GA 31768-6771

Mailing address

PO Box 2876
Moultrie, GA 31776-2876
Phone (229) 502-9788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20250108000048 GA Practitioner - Nurse Practitioner 0749718575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Urogynecology and Pelvic Surgery LLCGroup PAC ID 4880014133, 5 clinicians

Practice addresses (Care Compare)

115 31St Ave SE
Moultrie, GA 31768-6771
Phone (229) 502-1020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Urogynecology & Pelvic Surgery LLC CurrentSince Aug 29, 2024 Accepting new patients
Southern Pelvic Therapy LLC CurrentSince Jun 15, 2025 Accepting new patients

Locations

115 31st Ave SE
Moultrie, GA 31768
Phone (229) 502-1020

3131 Thomasville Hwy
Moultrie, GA 31768
Phone (229) 502-9769

403 Cowart Ave
Valdosta, GA 31602
Phone (229) 244-0034

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1306663455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-502-9788",
            "fax_number": "229-891-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 31ST AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686771",
            "telephone_number": "229-502-7988",
            "fax_number": "229-890-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARAMO",
        "first_name": "KEELY",
        "middle_name": "RADCLIFF",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-20",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "GA",
            "license": "RN176734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.