Kelly Courtney Shadwick, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

12332 Issued in NC

Practice address

2817 Rock Meritt Ave
Fort Liberty, NC 28310-1182

Phone

(910) 907-6982

Fax

(803) 328-1865

NPI assigned

Jul 19, 2010

Last updated

Oct 15, 2024By 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Steward Medical Group, Inc

  • Specialist
  • Watertown, MA
  • NPI 1629398219
  NPD

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1952614950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERITT AVE",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283101182",
            "telephone_number": "910-907-6982",
            "fax_number": "803-328-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADWICK",
        "first_name": "KELLY",
        "middle_name": "COURTNEY",
        "credential": "AU.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-19",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NC",
            "license": "12332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SA1792",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "19QFR",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE OF SC",
            "identifier": "1456498",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrice Sahvohn Scott, LCSW-C
• Crystal Seboe
• Shikira Sellers, DNP, MSN, RN, CCM
• Tayeshawn Larraine Sembly, DNP, APRN, FNP-BC
• Stephanie Jo Sexton, MD
• Victoria Lynn Shapiro, RD
• Sandra Shelton
• Cynthia Davis Sherin
• Glenn Curtis Simpson III, CRNA
• Alicia Sinclair

• Audiologist in Fort Liberty, NC
• Providers in Fort Liberty, NC by specialty
• Audiologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.