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Susannah Kelly Short

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1426 E Morehead St, Charlotte, NC 28204-2926

PECOS Enrollment

This provider is enrolled in PECOS as SUSANNAH SHORT.

Based on the most recent information from CMS, provider Susannah Kelly Short is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:59 PM.

Profile Details

Provider ID
1063044063
Provider Type
Individual
Full Name
Short, Susannah Kelly
Credential
FNP

Gender
Female
Sole Proprietor
No
Enumeration Date
2/7/2020
Last Updated
7/15/2024

Contact Information

Practice Location

1426 E Morehead St, Charlotte, NC 28204-2926

(704) 446-6090

Unlisted Fax

Mailing Location

PO Box 19305, Charlotte, NC 28219-9305

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5012828 North Carolina
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5012828 North Carolina

Susannah Kelly Short

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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