NPIMap

Individual provider Active NPI

Nichole A Kelly, N.P.

  • Family Nurse Practitioner
  • Waldoboro, ME
National Provider Identifier
1316058142
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R044014 Issued in ME
Practice address
27 Mill St
Waldoboro, ME 04572-6013
Phone
(207) 832-5291
NPI assigned
Aug 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 R044014 ME Primary

Addresses

Primary practice location

27 Mill St
Waldoboro, ME 04572-6013

Mailing address

27 Mill St
Waldoboro, ME 04572-6013
Phone (207) 832-5291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050629000636 ME Practitioner - Nurse Practitioner 6305882440 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

22 Station Ave
Brunswick, ME 04011-2092

329 Maine St
Brunswick, ME 04011-3310

730 Ctr St
Suite 9
Auburn, ME 04210-6316
Phone (207) 783-3450

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R044014MEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Nov 1, 2018 Accepting new patients
Penobscot Bay Physicians & Associates CurrentSince Oct 30, 2005 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth Family CurrentSince Nov 1, 2018 Accepting new patients
Mainehealth Past Accepting new patients

Locations

123 Medical Center Dr
Brunswick, ME 04011
Phone (207) 373-6800

329 Maine St
Ste A200
Brunswick, ME 04011
Phone (207) 373-4700

329 Maine St
Mere Point, ME 04011
Phone (207) 373-2250

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

3 Glen Cove Dr
#3
Rockport, ME 04856
Phone (207) 301-5400

4 Glen Cove Dr
Ste 5
Rockport, ME 04856
Phone (207) 592-5883

27 Mill St
Waldoboro, ME 04572
Phone (207) 832-2300

Interoperability endpoints

  • Direct secure messaging: nkelly10841@direct.mmc.mainehealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316058142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MILL ST",
            "city": "WALDOBORO",
            "state": "ME",
            "postal_code": "045726013",
            "telephone_number": "207-832-5291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 MILL ST",
            "city": "WALDOBORO",
            "state": "ME",
            "postal_code": "045726013",
            "telephone_number": "207-832-5291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICHOLE",
        "middle_name": "A",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "R044014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldoboro, ME

Sources for this page

Verify at the official NPI Registry.