Kenderlin Jovan Kelly

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018840 Issued in NC

Practice address

138 Hunter Cir
Fayetteville, NC 28304-3422

Phone

(910) 684-3593

NPI assigned

Mar 27, 2023

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Metro Treatment of North Carolina L P

  • Methadone Clinic
  • Charlotte, NC
  • NPI 1174739403
  NPD (past)
• Metro Treatment of North Carolina L P

  • Methadone Clinic
  • Fayetteville, NC
  • NPI 1588870877
  NPD (past)

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1609570548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 HUNTER CIR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043422",
            "telephone_number": "910-684-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 HUNTER CIR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043422",
            "telephone_number": "910-684-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KENDERLIN",
        "middle_name": "JOVAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-27",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Kelly, BT
• Catherine Margaret Kelly, M.D.
• Courtney Kelly
• Erwin A Kelly, LCMHC
• Kayte Kelly
• Lance Kelly
• Mary Charlene Kelly, MSW
• Regina Cassandra Kelly, LCSW
• Ryan Ashley Kelly
• William Huske Kelly, M.D.

• All providers in Fayetteville, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.