NPIMap

Individual provider Active NPI

Kelly Marie Van Fossen, D.O.

  • Surgery Physician
  • Fayetteville, NC
National Provider Identifier
1396957429
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2009-00374 Issued in NC
Practice address
4140 Ferncreek Dr Ste 601
Fayetteville, NC 28314-2569
Phone
(910) 485-3880
Fax
(910) 615-9618
NPI assigned
May 3, 2007
Last updated
Apr 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2009-00374 NC Primary

Addresses

Primary practice location

4140 Ferncreek Dr Ste 601
Fayetteville, NC 28314-2569

Mailing address

4140 Ferncreek Dr Ste 601
Fayetteville, NC 28314-2569
Phone (910) 485-3880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20090730000565 NC Practitioner - General Surgery 2668525148 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4140 Ferncreek Dr
Fayetteville, NC 28314-2563
Phone (910) 485-3880

4140 Ferncreek Dr
Suite 601
Fayetteville, NC 28314-2569
Phone (910) 485-3880

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc CurrentSince May 12, 2014 Accepting new patients
Cape Fear Valley Health Medical Group LLC Surgery CurrentSince Oct 15, 2025 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cape Fear Valley Health Medical Group LLC CurrentSince Oct 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC Current Accepting new patients
Owen Drive Surgical Clinic of Fayetteville PLLC Surgery CurrentSince Aug 1, 2009 Accepting new patients
Cumberland County Hospital System Inc Surgery CurrentSince May 12, 2014 Accepting new patients

Locations

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

513 Owen Dr
Fayetteville, NC 28304
Phone (910) 323-0101

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

4140 Ferncreek Dr
Ste 601
Fayetteville, NC 28314
Phone (910) 485-3880

4140 Ferncreek Dr
Fayetteville, NC 28314
Phone (910) 484-2171

Interoperability endpoints

  • Direct secure messaging: kvanfossen10315@capefearvalley.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1396957429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 FERNCREEK DR STE 601",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142569",
            "telephone_number": "910-485-3880",
            "fax_number": "910-485-5341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 FERNCREEK DR STE 601",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142569",
            "telephone_number": "910-485-3880",
            "fax_number": "910-615-9618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN FOSSEN",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2009-00374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.