Kellie Duvall Souther, in Mocksville, NC - Medicare Nurse Practitioner

Kellie Duvall Souther, is a medicare enrolled "Nurse Practitioner" in Mocksville, North Carolina. She graduated from nursing school in 2018 and has 6 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Wake Forest University Health Sciences and her current practice location is 1188 Yadkinville Rd, Mocksville, North Carolina. You can reach out to her office (for appointments etc.) via phone at (336) 716-7435.

Kellie Duvall Souther is licensed to practice in North Carolina (license number 5011023) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1558846527.

Contact Information

	Kellie Duvall Souther,
	1188 Yadkinville Rd, Mocksville, NC 27028-2037
	(336) 716-7435
	(336) 702-9277

Map and Direction

Provider's Profile

Full Name	Kellie Duvall Souther
Gender	Female
Speciality	Nurse Practitioner
Experience	6 Years
Location	1188 Yadkinville Rd, Mocksville, North Carolina
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Kellie Duvall Souther graduated from nursing school in 2018

NPI Data:

NPI Number: 1558846527
Provider Enumeration Date: 09/26/2018
Last Update Date: 12/05/2023

Medicare PECOS Information:

PECOS PAC ID: 6709121205
Enrollment ID: I20190102000876

Medical Identifiers

Medical identifiers for Kellie Duvall Souther such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1558846527	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	5011023 (North Carolina)	Secondary
363L00000X	Nurse Practitioner	5011023 (North Carolina)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
North Carolina Baptist Hospital	Winston-salem, NC	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Wake Forest University Health Sciences	4486564952	2048

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kellie Duvall Souther allows following entities to bill medicare on her behalf.

Entity Name	Wake Forest University Health Sciences
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1003803032 PECOS PAC ID: 4486564952 Enrollment ID: O20031105000436

Entity Name	Burke Primary Care Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1225085707 PECOS PAC ID: 1759339948 Enrollment ID: O20050104000943

Entity Name	Minuteclinic Diagnostic Of North Carolina Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1699748608 PECOS PAC ID: 6002837572 Enrollment ID: O20051212000719

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kellie Duvall Souther is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kellie Duvall Souther, 100 Kimel Forest Dr, Winston Salem, NC 27103-6074 Ph: (336) 713-0947	Kellie Duvall Souther, 1188 Yadkinville Rd, Mocksville, NC 27028-2037 Ph: (336) 716-7435

Reviews and Comments

Nurse Practitioner Nurses in Mocksville, NC

Mrs. Rebecca Ann Mcmahan, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 210 Hospital St, Mocksville, NC 27028 Phone: 336-753-6750 Fax: 336-751-0335
Kimberly Rae Siegrist, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 154 Government Center Dr, Mocksville, NC 27028 Phone: 980-859-9993
Miss Carol Elaine Gunden, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 485 Valley Rd, Mocksville, NC 27028 Phone: 336-751-8000 Fax: 336-751-8010
Kelli Nichols Case, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 485 Valley Rd, Mocksville, NC 27028 Phone: 336-751-8000 Fax: 336-751-8010
Brittney Elizabeth Grimes, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1188 Yadkinville Rd, Mocksville, NC 27028 Phone: 336-716-7435 Fax: 336-702-9277
Ms. Christina Marie Dodge, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 485 Valley Rd, Mocksville, NC 27028 Phone: 336-751-8000 Fax: 336-751-8010
Emily Draughn Collette, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1188 Yadkinville Rd, Mocksville, NC 27028 Phone: 336-716-7435 Fax: 336-702-9277

Kellie Duvall Souther, - Medicare Nurse Practitioner in Mocksville, NC