Kathleen Kelly Carroll, M.S., M.A., APRN-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

200401185 Issued in NC

Practice address

805 Westmont Dr
Fayetteville, NC 28305-4555

Phone

(910) 484-4061

Fax

(910) 485-4069

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

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

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Christian Counseling Professionals, Inc.Group PAC ID 1052459864, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science, Nurse Practitioner

State licenses

Practice roles

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.

• Christian Counseling Professionals, Inc.

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1598090763
  Medicare reassignment Care Compare group
• Carenet Inc

  • Professional Counselor
  • Winston Salem, NC
  • NPI 1376432492
  NPD (past)
• Carenet, Inc

  • Mental Health Counselor
  • Fayetteville, NC
  • NPI 1811167208
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1376674010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 WESTMONT DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283054555",
            "telephone_number": "910-484-4061",
            "fax_number": "910-485-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 WESTMONT DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283054555",
            "telephone_number": "910-484-4061",
            "fax_number": "910-485-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "KATHLEEN",
        "middle_name": "KELLY",
        "credential": "M.S., M.A., APRN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "6455",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "200401185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6113055",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Carrigan, RN
• Ginelle Carrington
• Samantha Carrington, WHNP
• Billie Jo Carroll
• Cynthia M Carroll, ITFS, M.ED
• Kaylee Carroll, RN
• Kelsey Stuart Carroll, OTR/L
• Lidia Lourdes Carroll, RT
• Lynnette Michelle Carroll, MAC,MSW,CCDC
• Meta Milele Carroll

• Psychiatric/Mental Health Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.