Individual provider Active NPI

Kathalene Antoinette Nottingham

  • Family Nurse Practitioner
  • Saint Albans, WV
National Provider Identifier
1447924469
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
08781 Issued in WV
Practice address
987 Elliot St
Saint Albans, WV 25177-3980
Phone
(304) 982-2104
NPI assigned
Aug 3, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 08781 WV Primary

Addresses

Primary practice location

987 Elliot St
Saint Albans, WV 25177-3980

Mailing address

987 Elliot St
Saint Albans, WV 25177-3980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20230221000261 WV Practitioner - Nurse Practitioner 3577935501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Charleston Cardiology AssociatesGroup PAC ID 1759376916, 4 clinicians

Practice addresses (Care Compare)

4607 Maccorkle Ave SW
Suite 300
South Charleston, WV 25309-1364
Phone 3047663688300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
55.65
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08781WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Charleston Cardiology Associates Single Specialty CurrentSince Dec 5, 2022 Accepting new patients

Locations

4607 Maccorkle Ave SW
Ste 300
South Charleston, WV 25309
Phone (304) 766-3688

4607 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-2800

Organizations & group practices 1

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1447924469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 ELLIOT ST",
            "city": "SAINT ALBANS",
            "state": "WV",
            "postal_code": "251773980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 ELLIOT ST",
            "city": "SAINT ALBANS",
            "state": "WV",
            "postal_code": "251773980",
            "telephone_number": "304-982-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOTTINGHAM",
        "first_name": "KATHALENE",
        "middle_name": "ANTOINETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "08781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Albans, WV

Sources for this page

Verify at the official NPI Registry.