Kelley Nicole Tate, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2002025550 Issued in MO

Practice address

1420 W Ashley Rd
Boonville, MO 65233-2112

Phone

(660) 882-6115

Fax

(660) 882-6120

NPI assigned

Jun 15, 2005

Last updated

Feb 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Kelley Malaney Former name

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Missouri, Columbia School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Empowerme Rehabilitation Missouri LLCGroup PAC ID 9234402470, 207 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empowerme Rehabilitation Missouri LLC

  dba EmpowerMe Rehab St. Charles

  • Multi-Specialty Clinic/Center
  • Saint Charles, MO
  • NPI 1417479494

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Empowerme Wellness Kansas City, LLC

  • Multi-Specialty Clinic/Center
  • Kansas City, MO
  • NPI 1083208391

  Physical Therapist

  Medicare reassignment NPD
• Empowerme Rehabilitation Missouri LLC

  • Rehabilitation Clinic/Center
  • Columbia, MO
  • NPI 1558932327

  Physical Therapist

  NPD
• Empowerme Wellness Kansas City, LLC

  • Rehabilitation Clinic/Center
  • Liberty, MO
  • NPI 1174299044
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1003811258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 S HARVEST RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652038764",
            "telephone_number": "573-474-5098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 W ASHLEY RD",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332112",
            "telephone_number": "660-882-6115",
            "fax_number": "660-882-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "KELLEY",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-15",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002025550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "484700802",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "650025700",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "122566",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "MALANEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thaddeus Garrison Stumph, D.D.S.
• Summers Pharmacy No 11 Inc (Summers Pharmacy - Long Term Care)
• Summers Pharmacy No 11 Inc (Summers Pharmacy - Boonville)
• Conner John Sutton, MD
• John Lee Tate, PTA
• Theresea Open Arms
• Michael Thompson, D.C.
• Shelby B Thompson, MSW, LMSW
• James S Thornbrugh, LPC
• Timothy R Tracy, D.P.T

• Physical Therapist in Boonville, MO
• Providers in Boonville, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.