Kellie Cain Henderson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN200046 Issued in GA

Practice address

1100 Northside Forsyth Dr
Suite 330
Cumming, GA 30041-6012

Phone

(770) 889-9901

NPI assigned

Oct 18, 2015

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

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Johns Creek Gastroenterology PCGroup PAC ID 0941269591, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: kellie.henderson@direct.johnscreekgastro.nextgenshare.com

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.

• Johns Creek Gastroenterology PC

  • Gastroenterology Physician
  • Cumming, GA
  • NPI 1821272345
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1445126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445126400000",
    "number": "1720459621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 NORTHSIDE FORSYTH DR",
            "address_2": "SUITE 330",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416012",
            "telephone_number": "770-889-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NORTHSIDE FORSYTH DR",
            "address_2": "SUITE 330",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416012",
            "telephone_number": "770-889-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KELLIE",
        "middle_name": "CAIN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-18",
        "last_updated": "2015-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN200046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Help U Speak, Inc.
• Kylie Helton
• Hemen Padhiar MD, PC (Northside Forsyth Family Medicine & Geriatrics)
• Yasamen Hemmati
• Justine Elodia Henao, D.O.
• Scott O. Henderson, DMD
• April Ann Hendry, CAC I
• Alexandra Herd
• Yitzchak Hermoni, M.D.
• Luz Elena Hernandez Vega, AGNP-C

• Family Nurse Practitioner in Cumming, GA
• Providers in Cumming, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.