Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelly Ryan Wackerle, MD

Individual provider Neurological Surgery Physician · NPI 1336671700

Kelly Ryan Wackerle, MD is a Neurosurgery in Charlotte, North Carolina. Qualified in 2017, 9 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
9
Licensed in
NC
In the registry since
2017
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2801 Randolph Rd Ste 100
Charlotte, NC 28211-1051
Phone: (704) 367-4800
Fax: (704) 316-3025
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2301 Erwin Rd, Durham, NC 27705-4699 — (919) 684-8111

Specialties & licences

Neurological Surgery Physician (primary) Taxonomy 207T00000X · Licence 2024-02000 (NC)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1336671700
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 3, 2017
Last updated in NPPESOctober 16, 2025
Certification dateOctober 16, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEUROSURGERY
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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