NPIMap

Individual provider Active NPI

Kelsey Cobb, FNP

  • Nurse Practitioner
  • Lake Charles, LA
National Provider Identifier
1336534064
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
894538 Issued in MS
Practice address
501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone
(337) 433-8400
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 894538 MS Primary
Family Nurse Practitioner 363LF0000X AP127701 TX

Addresses

Primary practice location

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724

Mailing address

1110 Broad Ave
Ste 500
Gulfport, MS 39501-8902
Phone (228) 575-2588

Other names 1

  • Kelsey Cannon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181016000901 MS Practitioner - Nurse Practitioner 9032421136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1110 Broad Ave
Suite 500
Gulfport, MS 39501-8902
Phone (228) 575-2588

Hospital & facility affiliations

  • Mississippi Homecare of Picayune Home health agency, Picayune, MS, CCN 257141
  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019
  • Ochsner Medical Center-Hancock Hospital, Bay Saint Louis, MS, CCN 250162

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
894538MSMDNurse Practitioner
AP127701TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jul 23, 2018 Accepting new patients
Imperial Health LLP Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

835 Thames Ave
Bay St Louis, MS 39520
Phone (228) 466-4977

1110 Broad Ave
Ste 500
Gulfport, MS 39501
Phone (228) 575-2588

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

Organizations & group practices 5

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 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1336534064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 BROAD AVE",
            "address_2": "STE 500",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395018902",
            "telephone_number": "228-575-2588",
            "fax_number": "228-864-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-433-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBB",
        "first_name": "KELSEY",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "894538",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP127701",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "CANNON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.