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Catherine Margaret Kelly

Family Medicine

Allopathic & Osteopathic Physicians

413 Owen Dr, Suite 201, Fayetteville, NC 28304-3411

PECOS Enrollment

This provider is enrolled in PECOS as CATHERINE KELLY.

Based on the most recent information from CMS, provider Catherine Margaret Kelly 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 6 days ago.

Profile Details

Provider ID
1871584425
Provider Type
Individual
Full Name
Kelly, Catherine Margaret
Title
Ms.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
11/2/2005
Last Updated
10/17/2007

Contact Information

Practice Location

413 Owen Dr, Suite 201, Fayetteville, NC 28304-3411

(910) 323-9111

(910) 484-2535

Mailing Location

413 Owen Dr, Suite 201, Fayetteville, NC 28304-3411

(910) 323-9111

(910) 484-2535

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 34794 North Carolina

Provider Identifiers

ID	Description	Issuer
ID 890169H	Description Medicaid	Issuer Unlisted North Carolina

Catherine Margaret Kelly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Fernandez, Gabriel I

Sangineni, Shireesha

Tagne Nouemssi, Alain Bruno

Brown, Josephine R

Born, Becky Leigh

Tran, Hung Vihn

Newkirk, Calbee Deiona

Bresley, Thomas Dean

Mehta Medical Services

Ray, John M