NPIMap

Organization Active NPI

Kids Care Pediatrics PA

  • Pediatrics Physician
  • Smithfield, NC
National Provider Identifier
1487612628
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDS CARE PEDIATRICS PA
Practice address
101 Kellie Dr
Smithfield, NC 27577-9443
Phone
(919) 938-3749
Fax
(919) 938-3795
NPI assigned
May 3, 2006
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Dr. Debra J Tetreault, M.D.NPI 1629036256
Title
President
Phone
(919) 938-3749

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Pediatric Nurse Practitioner 363LP0200X 147337 NC
Pediatrics Physician 208000000X NU Primary
Pediatric Adolescent Medicine Physician 2080A0000X NU

Addresses

Primary practice location

101 Kellie Dr
Smithfield, NC 27577-9443

Mailing address

101 Kellie Dr
Smithfield, NC 27577-9443
Phone (919) 938-3749

Other identifiers 1

IdentifierTypeStateIssuer
8902042MedicaidNC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1010483Kids Care Pediatrics101 Kellie Drive, Smithfield, NC 27577Certificate of waiverSep 7, 2027

National Provider Directory

National Provider Directory

Locations

101 Kellie Dr
Smithfield, NC 27577
Phone (919) 779-4800

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1487612628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 KELLIE DR",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275779443",
            "telephone_number": "919-938-3749",
            "fax_number": "919-938-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 KELLIE DR",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275779443",
            "telephone_number": "919-938-3749",
            "fax_number": "919-938-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CARE PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "TETREAULT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-938-3749",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "147337",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902042",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.