Kerrith Lyn Jaeckel, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

9700294 Issued in NC

Practice address

14215 Ballantyne Corporate PL
Suite 130
Charlotte, NC 28277-3671

Phone

(704) 384-1950

Fax

(704) 384-1955

NPI assigned

Apr 3, 2006

Last updated

Mar 7, 2023By 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 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  NPD
• Novant Medical Group, Inc.

  dba Novant Health Pediatric Sleep Medicine

  • Pediatric Sleep Medicine Physician
  • Charlotte, NC
  • NPI 1679050017
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1508828054",
    "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": "704-384-1950",
            "fax_number": "704-384-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14215 BALLANTYNE CORPORATE PL",
            "address_2": "SUITE 130",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773671",
            "telephone_number": "704-384-1950",
            "fax_number": "704-384-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAECKEL",
        "first_name": "KERRITH",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-03",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9700294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00295",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891050R",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjaeckel14598@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "14215 Ballantyne Corporate Pl",
            "address_2": "Suite 130",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282773671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allison Jacomin
• Gretchen Jacox, LCSW-P
• Heather Jacques
• Jade Integrative Counseling and Wellness, PLLC
• Jaded Joy Enterprises LLC
• Jaeda Jordan LLC
• Jaesan PC (SpeechWorks Therapy Services)
• Saeid Jafar-Pour, DDS
• Jaffe Chiropractic Clinic Inc PA
• Seth L Jaffe, DO

• Pediatrics Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.