Kim Kerry Neely, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

102318 Issued in NC

Practice address

2001 Van Haven Dr
Statesville, NC 28625-4342

Phone

(704) 942-7922

Fax

(704) 828-8248

NPI assigned

Nov 1, 2006

Last updated

Aug 6, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Longevity Accountable Care, PA

  • Geriatric Medicine (Family Medicine) Physician
  • Salisbury, NC
  • NPI 1396584454
  Medicare reassignment NPD
• Bomray Medical Clinic

  dba PrimeCare Medical Center

  • Primary Care Clinic/Center
  • Charlotte, NC
  • NPI 1013974864
  Medicare reassignment
• Sports and Spine Physical Therapy NC Inc

  dba Sportspine

  • Physical Therapy Clinic/Center
  • Charlotte, NC
  • NPI 1982651618
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1912084013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12824 DISTRICT SOUTH DR APT 6414",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775221",
            "telephone_number": "704-996-4973",
            "fax_number": "704-828-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAN HAVEN DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254342",
            "telephone_number": "704-942-7922",
            "fax_number": "704-828-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEELY",
        "first_name": "KIM",
        "middle_name": "KERRY",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "561976679",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• National Vision, Inc.
• Natural Beginnings Birth and Wellness Center
• Natural Beginnings Birth Center
• NC Immunology, PC (NC Immunology Allergy and Asthma)
• Donald Jeffrey Neal, D.O.
• Robert Bruce Neill III, CRNA
• Sherry Neilson, RN
• Melissa Walker Nelson
• New Arrows Counseling, PLLC
• New Country Family Chiropractic PLLC

• Physician Assistant in Statesville, NC
• Providers in Statesville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.