NPIMap

Individual provider Active NPI

Kelly Lee Myers, FNP-C

  • Family Nurse Practitioner
  • Ridgway, PA
National Provider Identifier
1881357903
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP025081 Issued in PA
Practice address
49 Ridgmont Dr Ste 1
Ridgway, PA 15853-9700
Phone
(814) 245-2119
Fax
(814) 245-2122
NPI assigned
Oct 15, 2021
Last updated
Dec 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP025081 PA Primary
Registered Nurse 163W00000X RN617747 PA

Addresses

Primary practice location

49 Ridgmont Dr Ste 1
Ridgway, PA 15853-9700

Mailing address

PO Box 270
Emporium, PA 15834-0270
Phone (814) 486-1115

Other practice location 1

90 E 2nd St
Emporium, PA 15834-1302
Phone (814) 486-1115 ext. 81451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220111000126 PA Practitioner - Nurse Practitioner 7012309792 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

49 Ridgmont Dr
Suite 1
Ridgway, PA 15853-9700
Phone (814) 245-2119

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN617747PAMDRegistered Nurse
SP025081PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Rural Health Consortia, Inc CurrentSince Dec 28, 2021 Accepting new patients
Keystone Rural Health Consortia, Inc. CurrentSince Dec 28, 2021 Accepting new patients
Keystone Rural Health Consortia, Inc. Current Accepting new patients
Keystone Rural Health Consortia Inc Past Accepting new patients

Locations

90 E 2nd St
Emporium, PA 15834
Phone (814) 486-0909

118 N Fraley St
Kane, PA 16735
Phone (814) 837-6313

49 Ridgmont Dr
#1
Ridgway, PA 15853
Phone (814) 245-2119

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1881357903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158340270",
            "telephone_number": "814-486-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 RIDGMONT DR STE 1",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158539700",
            "telephone_number": "814-245-2119",
            "fax_number": "814-245-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Emporium",
            "state": "PA",
            "postal_code": "158341302",
            "country_code": "US",
            "telephone_number": "814-486-1115 x81451",
            "fax_number": "814-486-0404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYERS",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-15",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP025081",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN617747",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgway, PA

Sources for this page

Verify at the official NPI Registry.