Kellie Deanne Tatro, PA-C, RRA, RT(R)

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

301411 Issued in NC

Practice address

4800 S Croatan Hwy
Nags Head, NC 27959-9704

Phone

(252) 449-5600

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, MD, DC3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Physicians of Mecklenburg County PLLCGroup PAC ID 3870635584, 8 clinicians

Outer Banks Professional Services, LLCGroup PAC ID 3173652096, 163 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

87.33

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Outer Banks Professional Services, LLC

  • Multi-Specialty Clinic/Center
  • Nags Head, NC
  • NPI 1891050357

  NC

  Medicare reassignment Care Compare group NPD
• Emergency Medicine Physicians of Mecklenburg County, PLLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1912232182

  NC

  Medicare reassignment Care Compare group
• Kinston Physicians Group, PLLC

  • Emergency Medicine Physician
  • Kinston, NC
  • NPI 1689923757

  NC

  Medicare reassignment
• Chester River Hospital Center

  • General Acute Care Hospital
  • Chestertown, MD
  • NPI 1679536809

  MD

  Medicare reassignment
• Emergency Medicine Associates P.a., P.C.

  • Emergency Medicine Physician
  • Falls Church, VA
  • NPI 1134117393

  DC, MD

  Medicare reassignment

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775692800000",
    "number": "1366905705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 S CROATAN HWY",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279599704",
            "telephone_number": "252-449-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 S CROATAN HWY",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279599704",
            "telephone_number": "252-449-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATRO",
        "first_name": "KELLIE",
        "middle_name": "DEANNE",
        "credential": "PA-C, RRA, RT(R)",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "243U00000X",
            "taxonomy_group": "",
            "desc": "Radiology Practitioner Assistant",
            "state": null,
            "license": "349813",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0010339",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "301411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gillian Lennox Stewart, DPT
• Holly Michele Strum
• Kerri Styn
• Karen A Supan-McPherson, M.D.
• Tar River LTC Group, LLC
• The Outer Banks Hospital Inc
• The Outer Banks Hospital Inc
• The Outer Banks Hospital Inc
• The Outer Banks Hospital, Inc.
• Thomas M. Buttke, PH.D., D.D.S., P.a.

• All providers in Nags Head, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.