Kelsey Stocum

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

1413 Issued in NC

Practice address

4651 Charlotte Park Dr Ste 100
Charlotte, NC 28217-3037

Phone

(704) 461-0006

Fax

(704) 461-0006

NPI assigned

Apr 17, 2025

Last updated

Apr 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Charlie Stocum Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amity Medical Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1003301300
  NPD

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

{
    "created_epoch": "1744848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1407642317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44308",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282150047",
            "telephone_number": "704-372-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 CHARLOTTE PARK DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173037",
            "telephone_number": "704-461-0006",
            "fax_number": "704-461-0006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 E W T Harris Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282154084",
            "country_code": "US",
            "telephone_number": "704-208-4134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOCUM",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-17",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NC",
            "license": "1413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLIE",
            "last_name": "STOCUM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kristi Stitt
• Naqualya Stitt
• Stmichaels Healthcare Services (The Chimes of Charlotte)
• Alfred Kenneth Stockin, DDS DENTIST
• Rebekah Anne Stockstill, PA-C
• Laura M Stoddard, MD
• Elisabeth Anne Stoffel, MD
• Bobbie C Stokes, MSHE
• Carolea A Stokes
• Christiana Cierra Stokes

• Community Health Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Community Health Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.