Kelcy Marie Carlson, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209023657 Issued in IL

Practice address

363 N West St
Olney, IL 62450-1160

Phone

(618) 392-9400

NPI assigned

Aug 3, 2021

Last updated

Aug 3, 2021By 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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Richland Memorial Hospital IncGroup PAC ID 3870565732, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Richland Memorial Hospital Hospital, Olney, IL, CCN 141355

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kcarlsonaprn334658@carlehiedirect.net

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.

• Richland Memorial Hospital, Inc

  dba Carle Richland Memorial Hospital

  • Critical Access Hospital
  • Olney, IL
  • NPI 1467492124
  Medicare reassignment Care Compare group NPD
• Carle Health Medical Group

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment NPD
• Richland Memorial Hospital, Inc

  • Otolaryngology Physician
  • Olney, IL
  • NPI 1700063179
  NPD
• Richland Memorial Hospital, Inc.

  • Rural Health Clinic/Center
  • Olney, IL
  • NPI 1053792689
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Richland Memorial Hospital, Inc

  dba Carle Richland Memorial Hospital

  • Critical Access Hospital
  • Olney, IL
  • NPI 1467492124
  Care Compare affiliation

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1124792288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 ILLINOIS ROUTE 15",
            "city": "ELLERY",
            "state": "IL",
            "postal_code": "628334409",
            "telephone_number": "618-302-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 N WEST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624501160",
            "telephone_number": "618-392-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "KELCY",
        "middle_name": "MARIE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-08-03",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209023657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Burgener
• Burgin Manor of Olney Inc
• Sandy Burke, LCPC
• Ashley Bussard
• Kathleen Carey, LCSW
• Trenton Clapp
• Paige Breanne Clayton, MD
• Rachel Clow, CPNP-PC
• Debra K Coad
• Carla Cole

• Psychiatric/Mental Health Nurse Practitioner in Olney, IL
• Providers in Olney, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.