Kanitra Shavon Clyburn, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5007846 Issued in NC

Practice address

13640 Steelecroft Pkwy
Ste 210
Charlotte, NC 28278-7565

Phone

(704) 512-6100

NPI assigned

Aug 5, 2015

Last updated

Jul 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclyburn89737@carolinashealthcaresystem.direct-ci.com

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.

• Carolinas Medical Center

  dba Atrium Health Levine Children's Gastroenterology

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Orthopedics & Sports Medici

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1437607686
  Medicare reassignment NPD
• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment NPD
• Carolinas Medical Center

  dba Atrium Health Primary Care Charlotte Internal Medicine

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1376893057
  NPD
• Carolinas Medical Center

  dba Atrium Health Pharmacy Kenilworth

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Diabetes Prevention

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Carolinas Physicians Network, Inc

  dba Atrium Health Virtual Care

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1578939914
  NPD
• Charlotte Pediatric Clinic

  dba Atrium Health Levine Children's Charlotte Pediatrics

  • Pediatrics Physician
  • Matthews, NC
  • NPI 1710914171
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health OB GYN Hospitalist

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1740848100
  NPD (past)
• Carolinas Physicians Network Inc.

  dba Atrium Health Imaging - Kenilworth

  • Vascular Surgery Physician
  • Charlotte, NC
  • NPI 1881624807

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1497131031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13640 STEELECROFT PKWY",
            "address_2": "STE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787565",
            "telephone_number": "704-512-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4501 Cameron Valley Pkwy",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282114297",
            "country_code": "US",
            "telephone_number": "704-367-7400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6235 Blakeney Park Dr",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282775658",
            "country_code": "US",
            "telephone_number": "704-512-5060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "332 N Trade St",
            "address_2": "Ste 1500",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281051728",
            "country_code": "US",
            "telephone_number": "704-512-6820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLYBURN",
        "first_name": "KANITRA",
        "middle_name": "SHAVON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-05",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5007846",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5007846",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kclyburn89737@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "13640 Steelecroft Pkwy",
            "address_2": "Ste 210",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282787565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cltspeech
• Club Success
• Chrystell Laura Cluck, PA-C
• Molly Kasson Clune
• Candace Charley Clyburn-Gamble, LCMHC
• Telisha S Clyburn
• Brittany Bergin Clyne, MD
• Stephen B Clyne, M.D.
• CM Counseling, PLLC
• CMC - Northeast, Inc. (NorthEast Pediatric Pulmonology-Charlotte)

• Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.