Jack Irvin Killman, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4036621 Issued in KY

Practice address

380 Suwannee Trail St
Bowling Green, KY 42103-7956

Phone

(270) 901-5000

NPI assigned

Mar 18, 2024

Sex

Male

Sole proprietor

Yes

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 KY

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

River Region Psychiatry Associates, LLCGroup PAC ID 1254491012, 118 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkillman112293@balladhealth.medalliesdirect.net

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

• River Region Psychiatry Associates LLC

  • Psychiatry Physician
  • Montgomery, AL
  • NPI 1386891497

  KY

  Medicare reassignment Care Compare group NPD
• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  NPD
• Wellmont Health System

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1760405849
  NPD

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1124887534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-901-5021",
            "fax_number": "270-393-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-901-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLMAN",
        "first_name": "JACK",
        "middle_name": "IRVIN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-18",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4036621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Key, RN
• Isaiah Key, DC
• Sonnarinh Khamvongsa, APRN
• Umar Khan, M.D.
• Kidney Specialist of Kentucky PLLC
• Hye Kim
• David Michael Kimbel, BC-HIS
• Kindred
• Kindred Minds LLC
• Kinex Medical Company, LLC

• Psychiatric/Mental Health Nurse Practitioner in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; 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.