Active NPI
Kelly Anne Taylor Headley, PA-C
- Medical Physician Assistant
- Daniel Island, SC
National Provider Identifier
1609062108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA1544
- Practice address
- 225 Seven Farms Dr Ste 108B
Daniel Island, SC 29492-8932 - Phone
- (854) 500-2326
- NPI assigned
- Sep 18, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA1544 | SC | Primary |
Addresses
Primary practice location
225 Seven Farms Dr Ste 108B
Daniel Island, SC 29492-8932
Mailing address
PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1544 | SC | MD | Psychologist |
| PA1544 | SC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1609062108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751461",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751461",
"telephone_number": "843-792-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 SEVEN FARMS DR STE 108B",
"city": "DANIEL ISLAND",
"state": "SC",
"postal_code": "294928932",
"telephone_number": "854-500-2326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR HEADLEY",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-18",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "PA1544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daniel Island, SC
- Karen Steeb, LPC
- Mikaela Nicole Strimpfel, RD, LD
- Jennifer Dixon Swartz, MD
- Sweet Dreams Nurse Anesthesiology of SC LLC
- Symbiosis Mental Health and Wellness, LLC
- Team Rehab Physical Therapy, P.C.
- Keith Horace Riley Teelucksingh, PHARM.D.
- Teeth DS Daniel Island LLC
- Teeth DS Daniel Island LLC
- Tenet South Carolina Island Medical, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.