Kerri L Wiley, NP-C
Individual provider Active NPI Nurse Practitioner · Lavonia, GA
NPI 1447565668 · NPPES record last updated May 5, 2011
Key facts
- NPI
- 1447565668
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 192545 (GA)
- Practice address
- 12192 Augusta Road
Lavonia, GA 30553-1209 - Phone
- (706) 356-1072
- Fax
- (706) 356-1457
- NPI assigned
- Aug 12, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Mission Behavioral Health LLC
Southern NP Associates LLC
Practice addresses (Care Compare)
Florence, AL 35634
Phone (256) 740-9306
611 W Market St
Athens, AL 35611-2460
Phone (205) 343-7300
Hospital & facility affiliations
- Athens Limestone Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160216000882 | AL | Practitioner - Nurse Practitioner | 3577757970 | Reassigns benefits to 3 organizations |
| I20161004000599 | TN | Practitioner - Nurse Practitioner | 3577757970 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 192545 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mission Behavioral Health, LLC | Current |
Accepting new patients | |
| Russellville Hospital Inc | Current |
Accepting new patients | |
| Russellville Hospital Inc | Current |
Accepting new patients |
Locations
15225 Highway 43
Ste I
Russellville, AL 35653
Phone (256) 331-2700
Interoperability endpoints
- kerri.wiley@gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 192545 | GA | Yes |
Addresses
Primary practice location
12192 Augusta Road
Lavonia, GA 30553-1209
Mailing address
12192 Augusta Road
Lavonia, GA 30553-1209
Phone (706) 356-1072
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 669649351A | Medicaid | GA |
Other providers in Lavonia, GA
All providers in Lavonia, GA · Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.