Kellie McAdams Watts, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3936-17 Issued in MS

Practice address

772 Lake Harbour Dr Ste 2
Ridgeland, MS 39157-4365

Phone

(601) 607-7876

NPI assigned

Jun 21, 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 MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Southern Smile Studio

  • Dental Clinic/Center
  • Brandon, MS
  • NPI 1992527287
  NPD Authorized official
• LD-Ridgeland, LLC

  • Dental Clinic/Center
  • Ridgeland, MS
  • NPI 1427762111
  NPD
• LD-Tupelo, LLC

  • Dental Clinic/Center
  • Tupelo, MS
  • NPI 1760995963
  NPD (past)

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1578083671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "772 LAKE HARBOUR DR STE 2",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574365",
            "telephone_number": "601-607-7876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "772 LAKE HARBOUR DR STE 2",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574365",
            "telephone_number": "601-607-7876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1763 Cliff Gookin Blvd",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388016723",
            "country_code": "US",
            "telephone_number": "662-842-2802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3999 N Gloster St",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388040950",
            "country_code": "US",
            "telephone_number": "662-778-2002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3999 N Gloster St",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388040950",
            "country_code": "US",
            "telephone_number": "662-778-2002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATTS",
        "first_name": "KELLIE",
        "middle_name": "MCADAMS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3936-17",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bert Preston Watkins, PT
• Katie Welborn Watkins, MPT
• Sierra D Watson
• Reneda S Watts-Anderson, PT
• Heather Marie Watts, LPTA
• Anna Catherine Way, M.S., CCC-SLP
• Uerasyah L Weatherspoon
• Brenna Weaver, LPC
• Alexandrea Webb, PHARM D
• Amy Sims Webb, OTR-L

• General Practice Dentistry in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.