Individual provider Active NPI

Kendrea Robinson, APRN

  • Family Nurse Practitioner
  • West Columbia, SC
National Provider Identifier
1861052425
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
22935 Issued in SC
Practice address
1053 Center St Ste 100
West Columbia, SC 29169-6749
Phone
(800) 491-0909
NPI assigned
Jun 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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 22935 SC Primary

Addresses

Primary practice location

1053 Center St Ste 100
West Columbia, SC 29169-6749

Mailing address

2142 Eaton Cir
Florence, SC 29501-6429
Phone (843) 245-6900

Other identifiers 1

IdentifierTypeStateIssuer
22935OtherSCSTATE BOARD LICENSE

Other names 1

  • Kendrea Moore Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Athena

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
I20190725002104 SC Practitioner - Nurse Practitioner 8325374515 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rosalyn Cares Consulting LLCGroup PAC ID 4688081425, 6 clinicians

Practice addresses (Care Compare)

1801 W Evans St
Suite 107
Florence, SC 29501-3801
Phone (888) 918-2415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Moore Care Therapy and Psychology Clinic CurrentSince Feb 1, 2022 Accepting new patients
SC House Calls Inc CurrentSince Jun 24, 2019 Accepting new patients
Rosalyn Cares Consulting LLC Family CurrentSince Jun 1, 2021 Accepting new patients
SC House Calls Inc CurrentSince Jun 24, 2019 Accepting new patients
Practical Purpose Solutions LLC CurrentSince Sep 12, 2021 Accepting new patients

Locations

1624 Main St
Columbia, SC 29201
Phone (803) 454-0365

660 Senior Way
Florence, SC 29505

1801 W Evans St
Ste 107
Florence, SC 29501
Phone (888) 918-2415

1053 Center St
West Columbia, SC 29169
Phone (803) 454-0365

1053 Center St
Ste 100
West Columbia, SC 29169

Organizations & group practices 5

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1861052425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 EATON CIR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295016429",
            "telephone_number": "843-245-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 CENTER ST STE 100",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291696749",
            "telephone_number": "800-491-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON",
        "first_name": "KENDREA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "22935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD LICENSE",
            "identifier": "22935",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Athena",
            "affiliation": "N",
            "address_1": "1053 Center St Ste 100",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291696749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KENDREA",
            "last_name": "MOORE",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Columbia, SC

Sources for this page

Verify at the official NPI Registry.