Individual provider Active NPI

Kelly Michelle Moss, NP

  • Family Nurse Practitioner
  • Statesville, NC
National Provider Identifier
1841640455
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5009456 Issued in NC
Practice address
700 Sullivan Rd
Statesville, NC 28677-3440
Phone
(704) 924-9111
Fax
(704) 883-0452
NPI assigned
Jun 14, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5009456 NC Primary

Addresses

Primary practice location

700 Sullivan Rd
Statesville, NC 28677-3440

Mailing address

PO Box 1845
Statesville, NC 28687-1845

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170612000000 NC Practitioner - Nurse Practitioner 9234422254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

276 Old Mocksville Rd
Suite 400
Statesville, NC 28625-1950
Phone (704) 878-6592

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, P.a. CurrentSince May 22, 2017 Accepting new patients
Piedmont Healthcare, PA CurrentSince May 22, 2017 Accepting new patients

Locations

700 Sullivan Rd
Statesville, NC 28677
Phone (704) 924-9111

276 Old Mocksville Rd
Ste 400
Statesville, NC 28625
Phone (704) 878-6592

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

276 Old Mocksville Rd
Ste 105
Statesville, NC 28625
Phone (704) 833-8262

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

393 3rd Ave SW
Taylorsville, NC 28681
Phone (704) 871-2163

Organizations & group practices 2

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": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1841640455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SULLIVAN RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773440",
            "telephone_number": "704-924-9111",
            "fax_number": "704-883-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "KELLY",
        "middle_name": "MICHELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5009456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.