Individual provider Active NPI

Kelsey Rae Gerughty, APRN

  • Adult Health Nurse Practitioner
  • N. Charleston, SC
National Provider Identifier
1912380296
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
3009576 Issued in KY
Practice address
9302 Medical Plaza Drive, Suite C
LTC Health Solutions
N. Charleston, SC 29406
Phone
(864) 751-6424
Fax
(864) 751-6430
NPI assigned
Jul 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 3009576 KY Primary

Addresses

Primary practice location

9302 Medical Plaza Drive, Suite C
LTC Health Solutions
N. Charleston, SC 29406

Mailing address

1624 Main Street
Agape Senior Primary Care, Inc., Dba LTC Health Solutio
Columbia, SC 29201
Phone (803) 454-0365

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20150811006074 KY Practitioner - Nurse Practitioner 9830404466

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1435881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484265600000",
    "number": "1912380296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 MAIN STREET",
            "address_2": "AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29201",
            "telephone_number": "803-454-0365",
            "fax_number": "803-404-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9302 MEDICAL PLAZA DRIVE, SUITE C",
            "address_2": "LTC HEALTH SOLUTIONS",
            "city": "N. CHARLESTON",
            "state": "SC",
            "postal_code": "29406",
            "telephone_number": "864-751-6424",
            "fax_number": "864-751-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERUGHTY",
        "first_name": "KELSEY",
        "middle_name": "RAE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-03",
        "last_updated": "2017-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "3009576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in N. Charleston, SC

Sources for this page

Verify at the official NPI Registry.