Individual ProviderKelly StevensPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2635 Lawndale Dr, Greensboro, NC 27408-4802(336) 867-4310(406) 322-1000PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Stevens is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:21 AM.Profile DetailsProvider ID1104811959Provider TypeIndividualFull NameStevens, KellyCredentialPAGenderFemaleSole ProprietorNoEnumeration Date9/19/2005Last Updated12/10/2024Contact InformationPractice LocationPractice Address2635 Lawndale Dr, Greensboro, NC 27408-4802Phone(336) 867-4310FaxUnlisted FaxMailing LocationMailing AddressPO Box 601843, Charlotte, NC 28260-1843Phone(406) 322-1000Fax(406) 322-5207Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense0010-11495North CarolinaCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense055.0031677VermontCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense41208MontanaCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA3513FloridaProvider IdentifiersIDDescriptionIssuerID291575800DescriptionMedicaidIssuerUnlistedFlorida