Kelly K Nelson, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

0101238648 Issued in VA

Practice address

21 Highland Ave SE
Suite 100
Roanoke, VA 24013-2201

Phone

(540) 344-9213

Fax

(540) 345-7559

NPI assigned

Aug 31, 2005

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

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Physicians to Children, Inc.

  • Pediatrics Physician
  • Roanoke, VA
  • NPI 1649362351
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1821081241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5625 JONAMAC PL",
            "address_2": "APT. 3A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240196126",
            "telephone_number": "540-977-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 HIGHLAND AVE SE",
            "address_2": "SUITE 100",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132201",
            "telephone_number": "540-344-9213",
            "fax_number": "540-345-7559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KELLY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "VA",
            "license": "0101238648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "126F1",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89126F1",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellyk.nelson.p1@direct.physicianstochildren.nextgenshare.com",
            "affiliation": "N",
            "address_1": "21 Highland Ave SE",
            "address_2": "Suite 100",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240132201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tara Neighbors, LCSW
• Neil L. Moser, LCSW,LLC
• Laurie Nelson-Lester, NP-C
• Alicia Erin Nelson, OTR/L
• Jacob Montgomery Nelson
• Lauren Elizabeth Nelson, MD
• Matthew Nelson
• Taylor Nelson, L.AC, DACM
• David Nesbitt, M.D.
• Travis Scott Neuberger, MD

• Pediatric Adolescent Medicine Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Pediatric Adolescent Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.