Keidra McCullough

Primary specialty

SpecialistTaxonomy code 174400000X

License

CT2780 Issued in NC

Practice address

314 Signal Hill Dr
Statesville, NC 28625-4357

Phone

(704) 450-9104

NPI assigned

Apr 27, 2026

Last updated

Apr 27, 2026By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

• Shear Grace Hair Studio LLC

  • Durable Medical Equipment & Medical Supplies
  • Statesville, NC
  • NPI 1194661769
  NPD Authorized official

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

{
    "created_epoch": "1777248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1477499101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 S MEETING ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286776108",
            "telephone_number": "704-450-9104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 SIGNAL HILL DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254357",
            "telephone_number": "704-450-9104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KEIDRA",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2026-04-27",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "C89143",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "CT2780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney McCarthy, MA/CAS
• Rebekah Jordan McCarthy, FNP
• Kiara McClain
• Macey Quinn Bowman McCoy, FNP
• Robbie B McCraw, LCMHC
• Tonya Nicole McDowell
• Lucy Charla McEachin, LMFT
• Jennifer Leigh McElroy, LMBT
• Jessica Lynn McEnaney, OTR
• Jordan Janai McGhee, LCSWA

• Specialist in Statesville, NC
• Providers in Statesville, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; 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.