Individual provider Active NPI

Kelly Theresa McKune, CNM

  • Advanced Practice Midwife
  • Alpharetta, GA
National Provider Identifier
1376652107
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
RN140331 Issued in GA
Practice address
3550 Preston Ridge Rd
Kaiser Permanente Alpharetta Medical Office
Alpharetta, GA 30005-3821
Phone
(773) 296-7032
Fax
(773) 296-3096
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 209005171 IL
Advanced Practice Midwife 367A00000X RN140331 GA Primary

Addresses

Primary practice location

3550 Preston Ridge Rd
Kaiser Permanente Alpharetta Medical Office
Alpharetta, GA 30005-3821

Mailing address

3495 Piedmont Rd NE
Nine Piedmont Center
Atlanta, GA 30305-1717
Phone (404) 364-7070

Other identifiers 1

IdentifierTypeStateIssuer
41.310797MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071102000318 GA Practitioner - Certified Nurse Midwife (CNM) 5092802363 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
209005171ILMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Advanced Practice Midwife CurrentSince Feb 25, 2025 Accepting new patients

Locations

3550 Preston Ridge Rd
Ofc
Alpharetta, GA 30005
Phone (770) 663-3181

3550 Preston Ridge Rd
Alpharetta, GA 30005
Phone (770) 663-3122

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

1435 Broadmoor Blvd
Sugar Hill, GA 30518
Phone (678) 765-5680

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1376652107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051717",
            "telephone_number": "404-364-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 PRESTON RIDGE RD",
            "address_2": "KAISER PERMANENTE ALPHARETTA MEDICAL OFFICE",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053821",
            "telephone_number": "773-296-7032",
            "fax_number": "773-296-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKUNE",
        "first_name": "KELLY",
        "middle_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": "209005171",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN140331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41.310797",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3550 Preston Ridge Rd",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300053821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.