Kelly Shuttera

Key facts

NPI

1356088264

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner 363LP0808X

License

110119463 (FL)

Practice address

100 N Main St
Chattahoochee, FL 32324-1107

Phone

(850) 663-7001

NPI assigned

May 13, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 4

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.

• Catalyst Counseling Associates LLC Community/Behavioral Health Agency · Saint Cloud, FL · NPI 1962049387
  Medicare reassignment Care Compare group NPD FL
• Florida Department of Children and Families General Acute Care Hospital · Chattahoochee, FL · NPI 1710945118
  Medicare reassignment NPD FL
• Florida Department of Children and Families Psychiatric Hospital · Macclenny, FL · NPI 1013931765
  NPD
• Florida Department of Children and Families Psychiatric Hospital · Chattahoochee, FL · NPI 1578895470
  NPD

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Catalyst Counseling Associates LLC (3 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 13, 2022.

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1356088264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1724 GURTLER CT APT 2",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046428",
            "telephone_number": "310-499-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "CHATTAHOOCHEE",
            "state": "FL",
            "postal_code": "323241107",
            "telephone_number": "850-663-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTTERA",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-13",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "110119463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattahoochee, FL

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• Marilou Lejano San Agustin, M.D.
• Connor Allen Schiffer, M.A.
• Bailey Clinton Singletary, DMD
• Nicholas Spragg, BCBA
• Amy Lynn Sterrett
• Azaia Stubbs, APRN
• Uldarico Badiongan Tan, M.D.

All providers in Chattahoochee, FL · Psychiatric/Mental Health Nurse Practitioner in Florida