Fayetteville Children's Clinic, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

39028 Issued in NC

Legal business name

FAYETTEVILLE CHILDREN'S CLINIC, P.A.

Practice address

1606 Morganton Rd
Fayetteville, NC 28305-4738

Phone

(910) 484-3121

Fax

(910) 484-9027

NPI assigned

Sep 27, 2006

Last updated

Jul 10, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William Huske Kelly, M.D.NPI 1548351372

Title

President

Phone

(910) 484-3121

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William Huske Kelly, M.D.

  • Pediatrics Physician
  • Fayetteville, NC
  • NPI 1548351372
  NPD (past) Authorized official
• Niveen Youssef Iskander, M.D.

  • Pediatrics Physician
  • Fayetteville, NC
  • NPI 1639260482
  NPD (past)
• Olga Khodakova Johnson, M.D.

  • Pediatrics Physician
  • Fayetteville, NC
  • NPI 1821225046
  NPD (past)
• Horace Robert Long, M.D.

  • Pediatrics Physician
  • Fayetteville, NC
  • NPI 1073604849
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1730270448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53127",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283053127",
            "telephone_number": "910-484-3121",
            "fax_number": "910-484-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 MORGANTON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283054738",
            "telephone_number": "910-484-3121",
            "fax_number": "910-484-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE CHILDREN'S CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HUSKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-484-3121",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "39028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0235G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790235G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fayetteville Anesthesia, P.a.
• Fayetteville Area Health Education Foundation Inc (Southern Regional Area Health Education Center)
• Fayetteville Area Health Education Foundation, Inc. (Southern Regional AHEC)
• Fayetteville Associates in Laboratory Medicine
• Fayetteville Breastfeeding Center Inc
• Fayetteville Chiropractic (Fayetteville Family Chiropractic)
• Fayetteville Chiropractic Solutions PA
• Fayetteville Counseling Services, PLLC
• Fayetteville Drugs LLC (Fayetteville Drugs)
• Fayetteville Endocrinology and Diabetes Clinic PA

• Pediatrics Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.