Individual provider Active NPI

Kristin Leigh Daniel

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1518588409
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5014173 Issued in NC
Practice address
190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946
Phone
(336) 765-6637
Fax
(336) 765-6964
NPI assigned
May 1, 2020
Last updated
Mar 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5014173 NC Primary
Medical-Surgical Registered Nurse 163WM0705X 245798 NC

Addresses

Primary practice location

190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kdaniel713508@direct.novanthealth.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210730000720 NC Practitioner - Nurse Practitioner 7214330034 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

190 Kimel Park Dr
Suite 125
Winston Salem, NC 27103-6946
Phone (336) 277-6009

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
245798NCMDMedical-Surgical Registered Nurse
5014173NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 12, 2021 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 12, 2021 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

152 E Kinderton Way
Ste 101
Bermuda Run, NC 27006
Phone (336) 893-3180

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

190 Kimel Park Dr
Ste 125
Winston Salem, NC 27103
Phone (336) 277-6009

190 Kimel Park Dr
Ste 155
Winston Salem, NC 27103
Phone (336) 765-6637

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

Organizations & group practices 4

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 2

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": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1518588409",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 155",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-6637",
            "fax_number": "336-765-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIEL",
        "first_name": "KRISTIN",
        "middle_name": "LEIGH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-01",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5014173",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NC",
            "license": "245798",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdaniel713508@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "190 Kimel Park Dr Ste 155",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.