Individual provider Active NPI

Kelly Moynes Sklare, CNM, NP-C

  • Advanced Practice Midwife
  • Lawrenceville, GA
National Provider Identifier
1609913896
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
RN169833 Issued in GA
Practice address
1942 Atkinson Rd
Suite 100
Lawrenceville, GA 30043-5004
Phone
(678) 775-0600
Fax
(678) 377-5284
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN169833 GA
Advanced Practice Midwife 367A00000X RN169833 GA Primary

Addresses

Primary practice location

1942 Atkinson Rd
Suite 100
Lawrenceville, GA 30043-5004

Mailing address

PO Box 116156
Atlanta, GA 30368-6156
Phone (678) 312-5525

Other names 1

  • Kelly Ann Moynes Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelly.sklarecnm.p2@direct.gmg.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070509000596 GA Practitioner - Certified Nurse Midwife (CNM) 8325144280 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Physician Group, LLC CurrentSince Sep 30, 2009 Accepting new patients

Locations

1942 Atkinson Rd
Ste 100
Lawrenceville, GA 30043
Phone (678) 775-0600

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1609913896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116156",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303686156",
            "telephone_number": "678-312-5525",
            "fax_number": "770-339-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 ATKINSON RD",
            "address_2": "SUITE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435004",
            "telephone_number": "678-775-0600",
            "fax_number": "678-377-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKLARE",
        "first_name": "KELLY",
        "middle_name": "MOYNES",
        "credential": "CNM, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN169833",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN169833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.sklarecnm.p2@direct.gmg.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1942 Atkinson Rd",
            "address_2": "Suite 100",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300435004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MOYNES",
            "middle_name": "ANN",
            "credential": "CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.