Kelly R Jeffery, RN, MSN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

68371 Issued in WV

Practice address

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311

Phone

(304) 414-4800

Fax

(304) 414-4801

NPI assigned

Jan 5, 2013

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

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

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

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 and National Provider Directory roles.

• Stonerise Services, LLC

  • Nurse Practitioner
  • Charleston, WV
  • NPI 1558743849

  Family

  Medicare reassignment NPD
• Matrix Medical Network of West

  • Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1942569033

  WV

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  WV

  Medicare reassignment NPD
• PA Post Acute Services PC

  • General Practice Physician
  • Masury, OH
  • NPI 1255057063
  NPD

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

{
    "created_epoch": "1357344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1346587706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11",
            "city": "MOUNT CARBON",
            "state": "WV",
            "postal_code": "251390011",
            "telephone_number": "304-767-8145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-414-4800",
            "fax_number": "304-414-4801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "172 Carmen Drive",
            "address_purpose": "LOCATION",
            "city": "Mount Carbon",
            "state": "WV",
            "postal_code": "251390011",
            "country_code": "US",
            "telephone_number": "304-767-8145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4605 MacCorkle Ave SW",
            "address_purpose": "LOCATION",
            "city": "South Charleston",
            "state": "WV",
            "postal_code": "253091311",
            "country_code": "US",
            "telephone_number": "304-414-4800",
            "fax_number": "304-414-4801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERY",
        "first_name": "KELLY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "68371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346587706",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassie Jarvis
• Steven Lee Jarvis, APRN
• Mark Edward Javins, PA-C
• Amber Jeffers
• Kiara S. Jefferson
• Beverly Jeffries
• Tristina Jeffries
• Betty Jenkins
• Charles Sean Jenkins
• Mary Jenkins

• Family Nurse Practitioner in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.