Susan Elizabeth Kelly, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN0000025532 Issued in TN

Practice address

239 Clifford Price Loop
Mooresburg, TN 37811-2337

Phone

(423) 754-9648

NPI assigned

Mar 24, 2019

Last updated

Mar 24, 2019By 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

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Evolution Medical and Aesthetics PLLC

  • Clinic/Center
  • Rogersville, TN
  • NPI 1578394995
  Medicare reassignment NPD Authorized official
• Omega Medical and Aesthetics PLLC

  • Family Nurse Practitioner
  • Mooresburg, TN
  • NPI 1578447181
  Medicare reassignment NPD Authorized official
• Instacare PLLC

  • Urgent Care Clinic/Center
  • Morristown, TN
  • NPI 1275146045
  Medicare reassignment NPD

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

{
    "created_epoch": "1553385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553385600000",
    "number": "1992265003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 CLIFFORD PRICE LOOP",
            "city": "MOORESBURG",
            "state": "TN",
            "postal_code": "378112337",
            "telephone_number": "423-754-9648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 CLIFFORD PRICE LOOP",
            "city": "MOORESBURG",
            "state": "TN",
            "postal_code": "378112337",
            "telephone_number": "423-754-9648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-24",
        "last_updated": "2019-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APRN0000025532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Rebecca Bland, PA-C
• Kristy Fowler
• William Eli Gass
• James F Kresse, MLDT-CLT
• Cassandra Mishurda
• Selena Marilyn Morris, CNA
• Omega Medical and Aesthetics PLLC
• Joshua Proffitt, MD

• Family Nurse Practitioner in Mooresburg, TN
• Providers in Mooresburg, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.