Kellie Nicole Meehan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP031261 Issued in PA

Practice address

451 3Rd Ave
Kingston, PA 18704-5802

Phone

(570) 288-6543

NPI assigned

Dec 9, 2024

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 PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Pediatric Associates of Kingston, LLC

  • Pediatrics Physician
  • Kingston, PA
  • NPI 1831201276
  NPD (past)

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1346056926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N MAIN ST",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051540",
            "telephone_number": "570-574-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 3RD AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045802",
            "telephone_number": "570-288-6543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEEHAN",
        "first_name": "KELLIE",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP031261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Hovey McGinnis, LCSW
• Med-One Supply, Inc.
• Medical Center of Northeastern PA LLC
• Medical Oncology Associates of Wyoming Valley, PC
• Medical Profesional Service, PC
• Mary Joan Meehan
• Merc Counseling Services, LLC
• Carlo Anthony Mercadante, LAT, ATC
• William R Mericle, LCSW
• Leah Alexandra Merrick, PA-C

• All providers in Kingston, PA
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.