Individual provider Active NPI

Michaela Antoinette Kean, APRN

  • Family Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1275264350
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN213021 Issued in GA
Practice address
2412 N Oak St
Valdosta, GA 31602-2567
Phone
(229) 244-1400
Fax
(229) 244-5512
NPI assigned
Jun 21, 2022
Last updated
Oct 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN213021 GA Primary

Addresses

Primary practice location

2412 N Oak St
Valdosta, GA 31602-2567

Mailing address

2412 N Oak St
Valdosta, GA 31602-2567
Phone (229) 244-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20220829002918 GA Practitioner - Nurse Practitioner 7012391873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Parrott Medical Clinic PCGroup PAC ID 1153467238, 4 clinicians

Practice addresses (Care Compare)

804 Northwood Park Dr
Valdosta, GA 31602-1392
Phone (229) 249-7888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN213021GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parrott Medical Clinic PC CurrentSince Aug 18, 2022 Accepting new patients

Locations

804 Northwood Park Dr
Valdosta, GA 31602
Phone (229) 249-7888

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1275264350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022567",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022567",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEAN",
        "first_name": "MICHAELA",
        "middle_name": "ANTOINETTE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN213021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.