Kelly Anne Kallis, CFNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

119187 Issued in GA

Practice address

101 Yorktown Dr
Fayetteville, GA 30214-1568

Phone

(770) 460-4285

NPI assigned

Jan 24, 2007

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/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.

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD
• Privia Pediatric Medical Group of Georgia LLC

  • Pediatrics Physician
  • Fayetteville, GA
  • NPI 1710385513
  NPD
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297900800000",
    "number": "1831244417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102321",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 YORKTOWN DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141568",
            "telephone_number": "770-460-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLIS",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2011-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "119187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikhil Kadle, MD
• Kaiser Foundation Health Plan of Georgia, Inc.
• Kaiser Permanente
• Ajay Kumar Kaja, MBBS
• Kaleidosoul LLC
• Vinisha Kalra
• Kiran J Kanji, M.D.
• Mukti Bhatia Kanji, D.O.
• Rashaundria Kanu, CCC-SLP
• Paul Constantine Karagiannis, MD

• Nurse Practitioner in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; 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.