Emily Morgan Kelley, CPNP-PC
Individual provider Active NPI Pediatric Nurse Practitioner · Potosi, MO
NPI 1447893003 · NPPES record last updated Nov 8, 2019
Key facts
- NPI
- 1447893003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 2019042808 (MO)
- Practice address
- 1 Southtowne Dr
Potosi, MO 63664-5729 - Phone
- (573) 438-9355
- NPI assigned
- Oct 25, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20200714001894 | MO | Practitioner - Nurse Practitioner | 5799108478 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019042808 | MO | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Mines Health Center | Current |
Accepting new patients | |
| Great Mines Health Center | Current |
Accepting new patients | |
| Great Mines Health Center | Past |
Accepting new patients |
Locations
1401 Maple St
Farmington, MO 63640
Phone (573) 664-1100
1 Black Knight Dr
Ste 1
Farmington, MO 63640
206 Church St
#4
Leadwood, MO 63653
512 State St
Ste 101
Mineral Point, MO 63660
1 Southtowne Dr
Potosi, MO 63664
Phone (573) 438-8401
Interoperability endpoints
- emily.kelley@gmhc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 2019042808 | MO | Yes |
Addresses
Primary practice location
1 Southtowne Dr
Potosi, MO 63664-5729
Mailing address
10235 Trail Tree Farm Rd
Irondale, MO 63648-2100
Phone (573) 330-5155
Other providers in Potosi, MO
- Inderjit Singh MD Facp LLC
- Jeffery Johnson
- Haley Juliette
- Angela Kearns
- Shayne S Keddy
- Marianne Klemm
- Edward William Lake
- Carolyn Coyne Maryan
- Christopher Ryan Massey
- Heather Renee Mathieson
All providers in Potosi, MO · Pediatric Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2019. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.