Kelly Briana Levitas, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

102908 Issued in NC

Practice address

8821 Blakeney Professional Dr
Charlotte, NC 28277-6594

Phone

(704) 887-1101

Fax

(704) 887-1102

NPI assigned

Dec 27, 2005

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

Other names 1

• Kelly Briana Diven Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1609853159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8821 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776594",
            "telephone_number": "704-887-1101",
            "fax_number": "704-887-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8821 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776594",
            "telephone_number": "704-887-1101",
            "fax_number": "704-887-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVITAS",
        "first_name": "KELLY",
        "middle_name": "BRIANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "102908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DIVEN",
            "middle_name": "BRIANA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Madison Levine
• Nicole Ann Levine, LCSW
• Renee Simcoe Levine, CRNA
• Stacy Levinson, O.D.
• Amelia Frye Leviste, PA
• Diana F. Levitt, LPC
• Marc Levitt
• Aaron A. Levy, DO
• Alanna Oliphant Levy
• Antoinette Donna-Marie Levy

• Medical Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; 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.