Kelsey Ann Nance-Judge, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004961 Issued in GA

Practice address

875 Flat Shoals Rd SE Ste 150
Conyers, GA 30094-6640

Phone

(770) 785-7669

NPI assigned

Dec 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1457062713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 WINTON WAY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303123818",
            "telephone_number": "678-773-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 FLAT SHOALS RD SE STE 150",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946640",
            "telephone_number": "770-785-7669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANCE-JUDGE",
        "first_name": "KELSEY",
        "middle_name": "ANN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taidesha Chanel Myrick, NP
• Shenell Myrie, PSY.D.
• Rajeev Nagaraj Mysorekar, M.D.
• Sepedeh Nabavi, M.D.
• Sarveswar I Naidu, MD
• Sitharam Chowdary Nandigam, MD
• Valerie Nash, NURSE PRACTITIONER
• National Vision, Inc.
• Candice Michele Neal, LPN
• David Wade Neckman

• Physical Therapy Assistant in Conyers, GA
• Providers in Conyers, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.