KELLY ANN TILLER


Address: 2100 Stantonsburg Road, 1 South Ent/ Urology Office, Greenville, NC 27834
Phone: 2528472619

KELLY ANN TILLER (NPI# 1760557920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1760557920
Entity Type Individual
Full Name KELLY ANN TILLER
Credential PA-C
Practice Address 2100 Stantonsburg Road
1 South Ent/ Urology Office
Greenville
NC 27834
Mailing Address 2100 Stantonsburg Road
1 South Ent/ Urology Dept.
Greenville
NC 27834-3763
Practice Telephone 2528472619
Mailing Telephone 2528472619
Enumeration Date 2006-11-22
Last Update Date 2019-06-27
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant 0110006584 VA Physician Assistants & Advanced Practice Nursing Providers
Y 363A00000X Physician Assistant 100809 NC Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
RAILROAD MEDICARE P00407688 01
DME MAC JURISDICTION C 1274070001 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
225 Clearfield Ave, Virginia Beach, VA 234621815 7574575100 7579613696

Other Providers KELLY TILLER

NPI Name Taxonomy Address Enumeration
1457897837 Kelly Tiller Nurse Practitioner 2000 E Greenville St, Suite 4500, Anderson, SC 29621-1580 2017-01-10

Office Location

Street Address 2100 STANTONSBURG ROAD
1 SOUTH ENT/ UROLOGY OFFICE
City GREENVILLE
State NC
Zip Code 27834

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780635193 Larry Michel Mcconathy Psychologist 2100 Stantonsburg Road, Pitt County Memorial Hospital, Psychology Department, Greenville, NC 27835-6028 2006-05-12
1457876138 Sidharth Mehta Student in an Organized Health Care Education/Training Program 2100 Stantonsburg Road, Greenville, NC 27834 2017-08-03
1700300019 Deepak Donthi Student in an Organized Health Care Education/Training Program 2100 Stantonsburg Road, Greenville, NC 27834 2017-07-28
1275063307 Bridget Renee Byquist Emergency Medicine 2100 Stantonsburg Road, Greenville, NC 27834 2017-06-12
1255566154 Teddie Wayne Gore Nurse Practitioner 2100 Stantonsburg Road, Echi At PCmh, Greenville, NC 27835 2009-05-20
1902931231 Ashley G. Mccabe Nurse Practitioner 2100 Stantonsburg Road, East Carolina Heart Institute, Greenville, NC 27835 2007-02-23
1154472553 Pamela Meadors Fox Nurse Practitioner 2100 Stantonsburg Road, Greenville, NC 27835 2007-01-15
1720157118 Sydney Chhabra Psychologist 2100 Stantonsburg Road, Greenville, NC 27835 2006-11-07
1730129701 Lyle Ray Cooper Hospitalist 2100 Stantonsburg Road, Greenville, NC 27835-6028 2006-06-07

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841801255 Nicholas Mcarthur Bennett Day Training, Developmentally Disabled Services 302 C, Greenville, NC 27834 2020-08-11
1275150245 Shelby Renee Jones Student in an Organized Health Care Education/Training Program East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 2020-06-25
1194347138 Soban Ahmad Student in an Organized Health Care Education/Training Program 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 2020-05-13
1427687789 Brandon Allen Yates Student in an Organized Health Care Education/Training Program 435 Clinic Drive, Greenville, NC 27834 2020-04-07
1144854407 Kristen Springer Dreyfus Marriage & Family Therapist 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 2020-02-26
1861038606 Southern Surgical Outpatient Surgery Center, Pa Clinic/Center 2457 Emerald Place, Greenville, NC 27834 2019-11-26
1003460569 Shaun Fitzpatrick Nurse Practitioner Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 2019-08-01
1649831496 Katherine Salome Ross Genetic Counselor, MS 524 Moye Blvd, Greenville, NC 27834 2019-06-24
1477011880 Lauren Bethune Scroggs Counselor 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 2019-03-05
1669998001 Idella's Care Home Community/Behavioral Health 2912 Lee Ct # 9a, Greenville, NC 27834 2017-08-17
Find all providers in zip 27834

Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1053924977 Caitlyn N Jetter Physician Assistant 7238 N State Route 49, Greenville, OH 45331-8302 2020-08-29
1720618291 Kaitlin Stover Physician Assistant 3444 Briarcliff Dr Apt K, Greenville, NC 27834-5419 2020-01-23
1962044321 Tyler Robert Tefft Physician Assistant 25 Draper St Apt 129, Greenville, SC 29611-4786 2019-10-17
1780157842 Briana Welch Denton Physician Assistant 2101 W Arlington Blvd # 100, Greenville, NC 27834-5758 2019-01-10
1548732027 Jennifer Pedersen Physician Assistant 14314 Canter Trl, Greenville, SC 29609-0964 2018-12-21
1972089092 Sarah Eileen Mann Physician Assistant 315 Greenville Blvd Se Ste 100, Greenville, NC 27858-5733 2018-07-11
1134588478 Sarah Roeser Physician Assistant 2090 W Arlington Blvd Ste B, Greenville, NC 27834-5727 2016-02-15
1992177760 Robert Chapman Physician Assistant 126 Milestone Way, Greenville, SC 29615-5065 2015-10-20
1497137756 Alexandra Brooks Physician Assistant 2706 Aileen St Ste B, Greenville, TX 75402-6486 2015-06-23
1558776633 David Jonathan Cutter Physician Assistant 1202 W Oak St Ste 200, Greenville, MI 48838-2155 2014-06-26
Find all providers in GREENVILLE

Competitor

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City GREENVILLE
Zip Code 27834

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Dataset Information

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.

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