Active NPI
Payton Thomas Kelly, PHARMD
- Pharmacist
- Fuquay Varina, NC
National Provider Identifier
1609465376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30194
- Practice address
- 1401 N Main St
Fuquay Varina, NC 27526-9024 - Phone
- (919) 567-2846
- NPI assigned
- Jan 15, 2021
- Last updated
- Jan 15, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 30194 | NC | Primary |
Addresses
Primary practice location
1401 N Main St
Fuquay Varina, NC 27526-9024
Mailing address
8302 Spotter Dr
Apex, NC 27502-7290
Phone (336) 940-7455
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30194 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610668800000",
"number": "1609465376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8302 SPOTTER DR",
"city": "APEX",
"state": "NC",
"postal_code": "275027290",
"telephone_number": "336-940-7455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 N MAIN ST",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275269024",
"telephone_number": "919-567-2846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "PAYTON",
"middle_name": "THOMAS",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-15",
"last_updated": "2021-01-15",
"certification_date": "2021-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "30194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.