Kelly Board, APRN, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704272053 Issued in MI

Practice address

1055 Howell Mill Rd NW
Atlanta, GA 30318-5557

Phone

(866) 849-0692

Fax

(888) 973-8821

NPI assigned

Feb 19, 2017

Last updated

Nov 28, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 13

Addresses

Other identifiers 1

Other names 1

• Kelly Gilliam Former name

Medicare fee-for-service enrollment

Enrolled in FL, TX, NC, AZ, IL, TN6 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 6

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Devoted Medical Group of Texas Inc

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1982202800
  Medicare reassignment NPD
• Devoted Medical NC PC

  • Primary Care Clinic/Center
  • Zirconia, NC
  • NPI 1295443554
  Medicare reassignment NPD
• Devoted Medical PC

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1467125203
  Medicare reassignment NPD
• Devoted Medical Group Professional Corporation

  • Primary Care Clinic/Center
  • Pembroke Pines, FL
  • NPI 1245838168

  AZ, TN

  Medicare reassignment
• Optumcare Florida Ci, LLC

  • Primary Care Clinic/Center
  • Winter Park, FL
  • NPI 1720506603
  NPD (past)

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

{
    "created_epoch": "1487462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764288000000",
    "number": "1649719915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 HOWELL MILL RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303185557",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOARD",
        "first_name": "KELLY",
        "credential": "APRN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-19",
        "last_updated": "2025-11-28",
        "certification_date": "2025-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209028496",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "CAPN.0101629",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "303204",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "1102491",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "GAA-NP003047",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024194779",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "37319",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "0033314",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704272053",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "LA",
            "license": "244045",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN9482729",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5018989",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "29709",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024999700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GILLIAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Newman Kwame Boakye-Ansa, MD
• Theophilus Boakye, MD
• Catherine Boalch, RPH, PHARM.D.
• Board of Regents of the University System of Georgia and on Behalf....
• Board of Regents of the University System of Georgia and on Behalf....
• Afua Sarpon Boaten, MD
• Adedoyin Boatin, PHARMD
• Connie Reynolds Boatman, MPA, PA-C
• Kenneth Carter Boatner, ED.D.,MPH
• Pamela Boatner, CNM

• Adult Health Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.