NPIMap

Individual provider Active NPI

Kelly Nicole Chisholm, CNP

  • Family Nurse Practitioner
  • Lambertville, MI
National Provider Identifier
1366870974
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.14762 Issued in OH
Practice address
7581 Secor Rd
Lambertville, MI 48144-9624
Phone
(734) 856-6306
NPI assigned
Oct 16, 2013
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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 APRN.CNP.14762 OH Primary

Addresses

Primary practice location

7581 Secor Rd
Lambertville, MI 48144-9624

Mailing address

7581 Secor Rd
Lambertville, MI 48144-9624
Phone (734) 856-6306

Other names 1

  • Kelly Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20140609001423 MI Practitioner - Nurse Practitioner 6305060583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

7581 Secor Rd
Lambertville, MI 48144-9624
Phone (734) 856-6360

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.14762OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health Physicians North Specialty Care LLC Nurse Practitioner CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health Physicians-North LLC CurrentSince May 30, 2014 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince May 30, 2014 Accepting new patients
Aspen Medical Partners LLC Nurse Practitioner Current Accepting new patients

Locations

7581 Secor Rd
Lambertville, MI 48144
Phone (734) 854-1800

2200 Jefferson Ave
Toledo, OH 43604
Phone (419) 241-1400

Interoperability endpoints

  • Direct secure messaging: ksmith137695@direct.bsmhealth.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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1366870974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7581 SECOR RD",
            "city": "LAMBERTVILLE",
            "state": "MI",
            "postal_code": "481449624",
            "telephone_number": "734-856-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7581 SECOR RD",
            "city": "LAMBERTVILLE",
            "state": "MI",
            "postal_code": "481449624",
            "telephone_number": "734-856-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-16",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.14762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lambertville, MI

Sources for this page

Verify at the official NPI Registry.