KELLY T DOUGLASS (NPI# 1275822074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275822074 |
| Entity Type | Individual |
| Full Name | KELLY T DOUGLASS |
| Credential | D.C. |
| Practice Address |
3689 Watermelon Rd Northport AL 35473-5139 |
| Practice Telephone | 2057581600 |
| Practice Fax Number | 2057586698 |
| Mailing Telephone | 2057581600 |
| Mailing Fax Number | 2057586698 |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-08-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 2335 | AL | Chiropractic Providers |
| N | 111N00000X | Chiropractor | 2508 | TN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BCBS | 4296256 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598198525 | Kelly Douglass | Nurse Practitioner | 1705 Warren Ave, Suite 303, Williamsport, PA 17701-2665 | 2013-08-13 |
| Street Address |
3689 WATERMELON RD |
| City | NORTHPORT |
| State | AL |
| Zip Code | 35473-5139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396843348 | Karen Brown | Chiropractor | 3689 Watermelon Rd, Northport, AL 35473-5139 | 2006-09-20 |
| 1104919497 | Capstone Chiropractic Center, P.C. | Chiropractor | 3689 Watermelon Rd, Northport, AL 35473-5139 | 2006-10-02 |
| 1043310055 | Jerry L Conway | Chiropractor | 3689 Watermelon Rd, Capstone Chiropractic Center, Northport, AL 35473-5139 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861002396 | Lacedric Crawford | Chore Provider | 13055 Garden Creek Lane, Northport, AL 35473 | 2020-08-10 |
| 1316585219 | Cerra Jordan Jackson | Family Medicine | 5710 Watermelon Road, Suite 600, Northport, AL 35473 | 2019-12-11 |
| 1033609748 | Kara Lynne Pate | Nurse Practitioner | 5710 Watermelon Rd Ste 600, Northport, AL 35473 | 2018-05-17 |
| 1134619059 | Vanessa Graves | Social Worker | 521 Energy Center Blvd Ste 1506, Northport, AL 35473 | 2018-05-16 |
| 1164930939 | Brandi Nail Hubbard | Family Medicine | 5004 Al-69, Northport, AL 35473 | 2018-01-16 |
| 1831554104 | Danielle Paulos | Pharmacist | 5137 Northcliff Dr, Northport, AL 35473 | 2015-12-30 |
| 1629497508 | Lauren Hanley | Nurse Practitioner | 4280 Watermelon Rd Ste 110, Northport, AL 35473 | 2014-04-08 |
| 1528372802 | Communication Advantage | Speech-Language Pathologist | 507 Energy Center Blvd Suite 301, West Al Speech Pathology, Northport, AL 35473 | 2010-07-29 |
| 1144467309 | Caroline J Day | Family Medicine | 5710 Watermelon Road, Suite 600, Northport, AL 35473 | 2009-01-09 |
| 1538311196 | Northridge Dialysis Center, LLC | Clinic/Center | 4400 Watermelon Road, Northport, AL 35473 | 2008-10-15 |
| Find all providers in zip 35473 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215462932 | Blake Baggett | Chiropractor | 917 Mcfarland Blvd, Northport, AL 35476-3373 | 2017-05-01 |
| 1104170406 | Kerry Thomas, Hill | Chiropractor | 1580 Lurleen Wallace Blvd., Northport, AL 35476 | 2012-11-08 |
| 1366794703 | Back To Fitness | Chiropractor | 1580 Lorleen Wallace Blvd., Northport, AL 35476 | 2012-10-10 |
| 1841344314 | Douglas Brian Wright | Chiropractor | 75 Woodbine Ave, Northport, NY 11768 | 2007-01-22 |
| 1093868549 | Davin L Halpern | Chiropractor | 842 Fort Salonga Rd., Suite 3, Northport, NY 11768-2251 | 2007-01-19 |
| 1760548226 | Agee Chiropractic, P.C. | Chiropractor | 2811 Lurleen B Wallace Blvd Ste 12, Northport, AL 35476-3257 | 2006-12-29 |
| 1609959899 | David T Hitt | Chiropractor | 2209 20th Ave, Northport, AL 35476-4213 | 2006-10-23 |
| 1780767657 | Alan P Sherr | Chiropractor | 220 Fort Salonga Rd, 25a, Northport, NY 11768 | 2006-10-23 |
| 1396843348 | Karen Brown | Chiropractor | 3689 Watermelon Rd, Northport, AL 35473-5139 | 2006-09-20 |
| 1285657312 | Nadine O'neill | Chiropractor | 120 Woodbine Ave, Northport, NY 11768-2897 | 2006-07-26 |
| Find all providers in NORTHPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.