Kelley Wallace Jacobs, DNP/FNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

18972 Issued in SC

Practice address

705 N 8TH Ave Ste 1a
Dillon, SC 29536-2549

Phone

(843) 774-2478

Fax

(843) 774-1826

NPI assigned

Apr 21, 2014

Last updated

Jul 28, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelley Lynn Wallace Former name

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dillon Internal Medicine Associates PAGroup PAC ID 5991617995, 8 clinicians

McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Medical Center - Dillon Hospital, Dillon, SC, CCN 420005

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0900120
• Direct secure messaging: kelleyjacobs@dilloninte.allscriptsdirect.net

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.

• Dillon Internal Medicine Associates PA

  • Internal Medicine Physician
  • Dillon, SC
  • NPI 1124115886
  Medicare reassignment Care Compare group NPD
• McLeod Physician Associates II

  • Family Medicine Physician
  • Florence, SC
  • NPI 1801990494
  Medicare reassignment Care Compare group NPD
• McLeod Physician Associates II

  dba McLeod Orthopaedics - Florence

  • Orthopaedic Surgery Physician
  • Florence, SC
  • NPI 1922555739
  NPD

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

• McLeod Medical Center-Dillon

  • General Acute Care Hospital
  • Dillon, SC
  • NPI 1598746141
  Care Compare affiliation

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

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1952721672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 N 8TH AVE STE 1A",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362549",
            "telephone_number": "843-774-2478",
            "fax_number": "843-774-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N 8TH AVE STE 1A",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362549",
            "telephone_number": "843-774-2478",
            "fax_number": "843-774-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KELLEY",
        "middle_name": "WALLACE",
        "credential": "DNP/FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "SC",
            "license": "18972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "WALLACE",
            "middle_name": "LYNN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lindsay Elizabeth Hyduke, PHARMD
• Inspiring Transportation LLC
• Jared Jackson Ivey
• Carolyn Ann Jackson, RN, BSN
• Megan Lee Jackson, PTA
• Kathryn Ann Jarvis, MD
• Jay Bee Medical Equipment Co.,Inc
• JD Crowns LLC
• Shelia D Jenkins
• Latoya Lynnette Johnson Sellers, RN

• Primary Care Nurse Practitioner in Dillon, SC
• Providers in Dillon, SC by specialty
• Primary Care Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.