Susan Elizabeth Kelly, FNP
Individual provider Active NPI Family Nurse Practitioner · Mooresburg, TN
NPI 1992265003 · NPPES record last updated Mar 24, 2019
Key facts
- NPI
- 1992265003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APRN0000025532 (TN)
- Practice address
- 239 Clifford Price Loop
Mooresburg, TN 37811-2337 - Phone
- (423) 754-9648
- NPI assigned
- Mar 24, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20221209002058 | TN | Practitioner - Nurse Practitioner | 2668881020 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN0000025532 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omega Medical and Aesthetics PLLC | Family | Current |
Accepting new patients |
| Instacare PLLC | Current |
Accepting new patients | |
| Evolution Medical and Aesthetics PLLC | Current |
Accepting new patients |
Locations
1338 Russell Ave
Jefferson Cty, TN 37760
Phone (423) 616-0705
8930 Cross Park Dr
Knoxville, TN 37923
Phone (423) 616-0705
1751 W Morris Blvd
Ste 3
Morristown, TN 37813
Phone (423) 839-0036
1532 W Andrew Johnson Hwy
Morristown, TN 37814
Phone (423) 353-1175
3815 Highway 66 S
Ste 1
Rogersville, TN 37857
Phone (423) 754-9648
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN0000025532 | TN | Yes |
Addresses
Primary practice location
239 Clifford Price Loop
Mooresburg, TN 37811-2337
Mailing address
239 Clifford Price Loop
Mooresburg, TN 37811-2337
Phone (423) 754-9648
Other providers in Mooresburg, TN
- Lindsay Rebecca Bland
- Kristy Fowler
- William Eli Gass
- James F Kresse
- Cassandra Mishurda
- Selena Marilyn Morris
- Omega Medical and Aesthetics PLLC
- Joshua Proffitt
All providers in Mooresburg, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2019. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.