Kim McCullough, F.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11013478 Issued in FL

Practice address

1367 Oakfield Dr
Brandon, FL 33511-4841

Phone

(813) 643-1242

Fax

(813) 643-1246

NPI assigned

May 17, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN, FL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Knox Winamac Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Knox, IN
  • NPI 1629248919
  Medicare reassignment NPD
• Health Testing Solutions, Inc.

  • Multi-Specialty Clinic/Center
  • Belle Glade, FL
  • NPI 1407566219
  NPD
• Kotila Chiropractic Inc

  • Chiropractor
  • Brandon, FL
  • NPI 1679874606
  NPD
• Knox-Winamac Community Health Centers, Inc.

  • Family Medicine Physician
  • Winamac, IN
  • NPI 1528000395
  NPD

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1174970487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 OAKFIELD DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114841",
            "telephone_number": "813-643-1242",
            "fax_number": "813-643-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1367 OAKFIELD DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114841",
            "telephone_number": "813-643-1242",
            "fax_number": "813-643-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KIM",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-17",
        "last_updated": "2023-09-26",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006232A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11013478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "k.mccullough@kwchc.ssdirect.aprima.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1002 S Edgewood Dr",
            "city": "Knox",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465348226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "k.mccullough@kwchc.ssdirect.aprima.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "none",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1367 Oakfield Dr",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335114841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• McClusky Enterprises Inc.
• Nicole Joy McConnell, M.D.
• Elizabeth McCormack
• Blair-Tiffany McCormick, LCSW
• William J McCormick, MS, PT
• Rachael McDaniel
• Katelyn Brooke McDonald, PMHNP-BC
• Robyn McDonald
• Tiffany Nicole McDonald, PMHNP-BC
• Troy Lemar McDonald

• Family Nurse Practitioner in Brandon, FL
• Providers in Brandon, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.