Active NPI
Kelly Kathryn Jerome, MS
- Mental Health Counselor
- Pittsboro, NC
National Provider Identifier
1528524600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 13568
- Practice address
- 690 Buckner Clark Rd
Pittsboro, NC 27312-9052 - Phone
- (219) 308-0103
- NPI assigned
- Feb 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 13568 | NC | Primary |
Addresses
Primary practice location
690 Buckner Clark Rd
Pittsboro, NC 27312-9052
Mailing address
690 Buckner Clark Rd
Pittsboro, NC 27312-9052
Phone (219) 308-0103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13568 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717545600000",
"number": "1528524600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "690 BUCKNER CLARK RD",
"city": "PITTSBORO",
"state": "NC",
"postal_code": "273129052",
"telephone_number": "219-308-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "690 BUCKNER CLARK RD",
"city": "PITTSBORO",
"state": "NC",
"postal_code": "273129052",
"telephone_number": "219-308-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEROME",
"first_name": "KELLY",
"middle_name": "KATHRYN",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-14",
"last_updated": "2024-06-05",
"certification_date": "2024-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "13568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.