Individual provider Active NPI

Kelly Metts Humphries, APRN

  • Family Nurse Practitioner
  • Moncks Corner, SC
National Provider Identifier
1821850447
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN28247RX Issued in SC
Practice address
1043 Black Tom Rd
Moncks Corner, SC 29461-8816
Phone
(843) 860-7535
NPI assigned
Jan 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 28247 SC
Occupational Health Nurse Practitioner 363LX0106X APN28247RX SC
Family Nurse Practitioner 363LF0000X APN28247RX SC Primary

Addresses

Primary practice location

1043 Black Tom Rd
Moncks Corner, SC 29461-8816

Mailing address

1043 Black Tom Rd
Moncks Corner, SC 29461-8816
Phone (843) 860-7535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20250122003514 SC Practitioner - Nurse Practitioner 9931638897 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN28247RXSCMDOccupational Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care CurrentSince May 1, 2025 Accepting new patients
Carolina Family Care, Inc CurrentSince May 1, 2025 Accepting new patients
Musc Community Physicians CurrentSince Dec 1, 2025 Accepting new patients
Musc Community Physicians CurrentSince Dec 1, 2025 Accepting new patients
Novant Health Urgent Cares LLC CurrentSince Jan 18, 2025 Accepting new patients
Carolina Family Care, Inc Past Accepting new patients

Locations

6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

169 Ashley Ave
Charleston, SC 29425
Phone (843) 792-3072

459 N Highway 52
Moncks Corner, SC 29461
Phone (843) 889-3870

1208 Two Island Ct
Mt Pleasant, SC 29466
Phone (843) 884-6653

200 Ports Authority Dr
Mt Pleasant, SC 29464
Phone (843) 876-1560

2475 Broad St
Sumter, SC 29150
Phone (803) 778-6555

Interoperability endpoints

  • Direct secure messaging: kellis533673@direct.musc.edu

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1821850447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 BLACK TOM RD",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294618816",
            "telephone_number": "843-860-7535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 BLACK TOM RD",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294618816",
            "telephone_number": "843-860-7535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHRIES",
        "first_name": "KELLY",
        "middle_name": "METTS",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-29",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "28247",
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "SC",
            "license": "APN28247RX",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "APN28247RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

Verify at the official NPI Registry.