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KEANNA NELSON CCC-SLP
NPI 1386635191
Speech-Language Pathologist in Fayetteville, GA

Active since November 01, 2005
175 BRADFORD SQ STE A, FAYETTEVILLE, GA 30215(678) 438-7168(470) 377-8097 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 16, 2025, Dec 11, 2018 (2 updates tracked since 2018).

About Keanna Nelson Ccc-slp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEANNA NELSON CCC-SLP (NPI 1386635191) is an individual speech-language pathologist provider in Fayetteville, Georgia, licensed in Georgia (SLP006202) and active in the NPI registry since November 2005. She is a graduate of Other (2004).

NPPES Registry Identity

NPI1386635191
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameKEANNA NELSONCredential: CCC-SLP
Location Address175 BRADFORD SQ STE AFayetteville, GA 30215
Mailing Address210 Mcintosh Place DrFayetteville, GA 30214-7384 · (678) 485-1470 · Fax (470) 377-8097
Phone(678) 438-7168
Fax(470) 377-8097
Sole ProprietorYes
Medical School CMSOtherGraduated 2004
Enumeration DateNovember 1, 2005
Last NPPES UpdateMay 16, 20252 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1386635191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
License✔ Licensed in GA · SLP006202
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
175 BRADFORD SQ STE A, Fayetteville, GA 30215
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keanna Nelson Ccc-slp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7113185034
PECOS Enrollment IDI20120223000701

Medicare Billing Reassignment

Medicare enrollment records show Keanna Nelson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Fox Rehabilitation Ga, LLC
38 mi
Physical Therapist
1260 HIGHTOWER TRL
Atlanta, GA 30350
  • Reassigned Medicare billing, Georgia enrollment
  • 220 clinicians in this Medicare group
NPI 1023544624 (877) 407-3422

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SPEECH ASSESSMENT CENTER, INC.
Speech-Language Pathologist
175 BRADFORD SQ STE A
FAYETTEVILLE, GA 30215
Fayette County (678) 438-7168

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keanna Nelson's NPI number?

The NPI number for Keanna Nelson is 1386635191. It was assigned to this individual provider in the NPPES registry on November 1, 2005.

Where is Keanna Nelson located?

Keanna Nelson practices at 175 Bradford Sq Ste A, Fayetteville, GA 30215. The listed phone number is (678) 438-7168.

What is Keanna Nelson's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Is Keanna Nelson enrolled in Medicare?

Yes. Keanna Nelson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Keanna Nelson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Keanna Nelson reassigns Medicare benefits to Fox Rehabilitation Ga, LLC (Atlanta, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Keanna Nelson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Keanna Nelson was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.