Kelli Alicia Boatright
Individual provider Active NPI Family Nurse Practitioner · Vidalia, GA
NPI 1972287167 · NPPES record last updated Jun 9, 2023
Key facts
- NPI
- 1972287167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN295084 (GA)
- Practice address
- 1 Meadows Pkwy
Vidalia, GA 30474-8759 - Phone
- (912) 535-5555
- NPI assigned
- Jun 9, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Montgomery Emergency Group, LLC
Peachtree Immediate Care FP, LLC
Practice addresses (Care Compare)
1 Meadows Pkwy
Vidalia, GA 30474-8759
Phone (912) 535-5429
1912 Memorial Dr
Waycross, GA 31501-0913
Phone (912) 283-7100
Hospital & facility affiliations
- Memorial Satilla Health
- Bacon County Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.21 of 100
- Quality
- 84.26
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230828001516 | GA | Practitioner - Nurse Practitioner | 2769845593 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachtree Immediate Care FP, LLC | Current |
Accepting new patients | |
| Montgomery Emergency Group, LLC | Current |
Accepting new patients | |
| Trimed Advance Health, LLC | Current |
Accepting new patients |
Locations
590 Lanier Ave W
Fayetteville, GA 30214
3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900
1 Meadows Pkwy
Vidalia, GA 30474
Phone (912) 535-5429
2015 Alice St
Waycross, GA 31501
Phone (912) 283-2120
1912 Memorial Dr
Waycross, GA 31501
Phone (912) 283-7100
Interoperability endpoints
- kelli.boatright.1@18622.direct.athenahealth.com
- https://api.platform.athenahealth.com/18622/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN295084 | GA | Yes |
Addresses
Primary practice location
1 Meadows Pkwy
Vidalia, GA 30474-8759
Mailing address
1 Meadows Pkwy
Vidalia, GA 30474-8759
Phone (912) 535-5555
Other providers in Vidalia, GA
- Bhimani Internal Medicine
- Bio-Medical Applications of Georgia, Inc.
- Benjamin Roland Black
- Blount Youth Home of Georgia, Inc
- Brandon Reeves Blount
- Etta Wilcia Boss Cole
- Jo-Anna Elizabeth Boutwell
- Shannon Brantley
- Bailey Brooks
- Darren William Brow
All providers in Vidalia, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.