Caron Bowen Kelly, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN218152 Issued in GA

Practice address

3027 Jim Moore Rd
Dacula, GA 30019-1144

Phone

(770) 339-0129

NPI assigned

Oct 11, 2017

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

Medicare fee-for-service enrollment

Enrolled in GA

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Emory Clinic Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396798229
  Medicare reassignment NPD
• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1578073912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 JIM MOORE RD",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191144",
            "telephone_number": "770-339-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3027 JIM MOORE RD",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191144",
            "telephone_number": "770-339-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CARON",
        "middle_name": "BOWEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-11",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN218152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ukoha Kalu
• Tiffany Rogers Kearney, PHD, APC
• Sydni Alesha Kearse, OTR/L
• Hiwot Tadele Kebede, RRT
• Olubukola O Kehinde
• Diane Collette Kelly, DMD
• Jennifer Kennedy, COTA/L
• Arif Khan
• Nicole Killian
• Kim Hiott, LLC

• Family Nurse Practitioner in Dacula, GA
• Providers in Dacula, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.