Individual provider Active NPI

Lacy Godwin Kells, DPT

  • Physical Therapist
  • Fayetteville, NC
National Provider Identifier
1972732188
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12179 Issued in NC
Practice address
501 Executive PL
Fayetteville, NC 28305-5390
Phone
(910) 423-5550
Fax
(910) 423-5552
NPI assigned
Jul 9, 2009
Last updated
Jun 19, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 12179 NC
Physical Therapist 225100000X 12179 NC Primary

Addresses

Primary practice location

501 Executive PL
Fayetteville, NC 28305-5390

Mailing address

501 Executive PL
Fayetteville, NC 28305-5390
Phone (910) 423-5550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12179NCMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371600000000",
    "number": "1972732188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055390",
            "telephone_number": "910-423-5550",
            "fax_number": "910-423-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055390",
            "telephone_number": "910-423-5550",
            "fax_number": "910-423-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLS",
        "first_name": "LACY",
        "middle_name": "GODWIN",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2013-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "12179",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "12179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.