NPIMap

Individual provider Active NPI

Kelly Jackson Coleman, FNP

  • Nurse Practitioner
  • Matthews, NC
National Provider Identifier
1497107536
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5008693 Issued in NC
Practice address
1401 Matthews Township Pkwy Ste 110
Matthews, NC 28105-5403
Phone
(704) 316-3131
Fax
(704) 316-3132
NPI assigned
Jul 12, 2016
Last updated
Feb 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5008693 NC
Nurse Practitioner 363L00000X 5008693 NC Primary

Addresses

Primary practice location

1401 Matthews Township Pkwy Ste 110
Matthews, NC 28105-5403

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-3131

Other practice location 1

1718 E 4th St
Suite 501
Charlotte, NC 28204-3261
Phone (704) 343-9800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kcoleman394517@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161102002191 NC Practitioner - Nurse Practitioner 9830477439 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Presbyterian HospitalGroup PAC ID 1153231907, 412 clinicians

Practice addresses (Care Compare)

1401 Matthews Township Pkwy
Suite 110
Matthews, NC 28105-5403
Phone (704) 264-3500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5008693NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Presbyterian Hospital Current Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Sep 1, 2016 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Sep 19, 2020 Accepting new patients
The Presbyterian Hospital CurrentSince Sep 1, 2016 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Sep 1, 2016 Accepting new patients
The Presbyterian Hospital CurrentSince Sep 1, 2016 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

125 Baldwin Ave
Ste 200
Charlotte, NC 28204
Phone (704) 384-5043

125 Queens Rd
Ste 330
Charlotte, NC 28204
Phone (704) 384-5043

1718 E 4th St
Ste 201
Charlotte, NC 28204
Phone (704) 384-0560

1718 E 4th St
Ste 501
Charlotte, NC 28204
Phone (704) 868-3256

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

1401 Matthews Township Pkwy
Ste 110
Matthews, NC 28105
Phone (704) 264-3500

134 Medical Park Rd
Ste 200
Mooresville, NC 28117
Phone (704) 384-7972

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: kcoleman394517@direct.novanthealth.org

Organizations & group practices 10

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.

Hospital & facility affiliations 6

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": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1497107536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-316-3131",
            "fax_number": "704-316-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MATTHEWS TOWNSHIP PKWY STE 110",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055403",
            "telephone_number": "704-316-3131",
            "fax_number": "704-316-3132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1718 E 4th St",
            "address_2": "Suite 501",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043261",
            "country_code": "US",
            "telephone_number": "704-343-9800",
            "fax_number": "704-347-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "KELLY",
        "middle_name": "JACKSON",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5008693",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5008693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcoleman394517@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1718 E 4th St",
            "address_2": "Suite 501",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

Verify at the official NPI Registry.