Look up the most recent NPI and PECOS records

Kelly Marie De Groot

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

901 E 4th St Ste D, Charlotte, NC 28204-2622

PECOS Enrollment

This provider is enrolled in PECOS as KELLY DE GROOT.

Based on the most recent information from CMS, provider Kelly Marie De Groot is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not 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
1538753983
Provider Type
Individual
Full Name
De Groot, Kelly Marie
Gender
Female

Sole Proprietor
No
Enumeration Date
2/25/2021
Last Updated
5/22/2023

Contact Information

Practice Location

901 E 4th St Ste D, Charlotte, NC 28204-2622

(866) 434-3255

Unlisted Fax

Mailing Location

901 E 4th St Ste D, Charlotte, NC 28204-2622

(866) 434-3255

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5015315 North Carolina

Kelly Marie De Groot

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Morford, Brooke Ann

Cousen, Yolanda Shauntai

Coleman, Dionne

Norman, Emma Paige

Heslop, Jaclyn Leigh

Brown, Brandy Latisha

York, Lisa Coppedge

Fesel, Nicole Marie

Takon, Lovina;

Bjuro, Dana