William S. Kelly MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40743 Issued in NC

Legal business name

WILLIAM S. KELLY MD PA

Practice address

420 W Mountain St
Kernersville, NC 27284-2534

Phone

(336) 993-1618

Fax

(336) 993-5512

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Joanelle V Kelly

Title

Office Manager

Phone

(336) 993-1618

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kernersville Primary Care Doing business as

Locations

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1972566933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W MOUNTAIN ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842534",
            "telephone_number": "336-993-1618",
            "fax_number": "336-993-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W MOUNTAIN ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842534",
            "telephone_number": "336-993-1618",
            "fax_number": "336-993-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM S. KELLY MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JOANELLE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "336-993-1618",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "40743",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "40743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080107394",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890293K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kernersville Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Castevdral Whitsett
• Ruth Heather Whyte, OTR/L
• Charmaine Wiggins
• Sarah Amanda Marie Wilcox
• Brianna Wiley
• Nadia L Williams-Murry
• Amari J Williams
• Carolyn Williams
• Christopher Williams
• Crystal L Williams

• Family Medicine Physician in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; 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.