Kelly Jean Duffy, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2014-00111 Issued in NC

Practice address

114 Kinderton Blvd
Advance, NC 27006-7302

Phone

(336) 998-9742

Fax

(336) 998-9410

NPI assigned

Apr 22, 2011

Last updated

Jul 30, 2014By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Wake Forest Health Network LLC

  dba Atrium Health Wake Forest Baptist Pediatrics - Greensboro

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756
  Medicare reassignment NPD
• Wake Forest Health Network, LLC

  dba Atrium Health Wake Forest Baptist Shapiro Eye Care - Greensboro

  • Ophthalmology Physician
  • Greensboro, NC
  • NPI 1003114992
  NPD
• Wake Forest Health Network, LLC

  dba Atrium Health Levine Children's Pediatrics Northwest

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1053175299
  NPD
• Cornerstone Health Care PA

  • Cardiovascular Disease Physician
  • Statesville, NC
  • NPI 1275914046
  NPD (past)
• Wake Forest Health Network LLC

  dba Atrium Health Wake Forest Baptist Family Medicine - Granite Falls

  • Family Medicine Physician
  • Granite Falls, NC
  • NPI 1770858938
  NPD (past)

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

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406678400000",
    "number": "1801187059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WESTCHESTER DR",
            "address_2": "STE 850",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "336-802-2400",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 KINDERTON BLVD",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067302",
            "telephone_number": "336-998-9742",
            "fax_number": "336-998-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-22",
        "last_updated": "2014-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "172764",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2014-00111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Digestive Health Specialists, PA
• Adam T. Dorsett, D.D.S
• Dr. Todd Carter D.D.S
• Gabriella Drouillard-Moser, M.A., M.A.,
• Jeffrey William Duffy, D.D.S.
• Jayme Nance Earle, M.S., CCC-SLP
• Eckerd Corporation (Rite Aid Pharmacy 11310)
• Kerry Eileen Eisinger, COTA
• Loraine Grace Engstrom, OTR/L
• Family Solutions Center

• Pediatrics Physician in Advance, NC
• Providers in Advance, 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 30, 2014; 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.