Kelly Tickle, PCNS-BC, PPCNP-BC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APRN-NP228738 Issued in GA

Practice address

5455 Meridian Marks Rd Ste 400
Atlanta, GA 30342-4723

Phone

(404) 785-3240

Fax

(404) 785-3600

NPI assigned

Jan 8, 2014

Last updated

Oct 31, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ktickle66826@choa.gadirect.net

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.

• Choa Hospital Based, LLC

  • Pediatrics Physician
  • Brookhaven, GA
  • NPI 1457695488
  NPD (past)

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

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1417379538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 MERIDIAN MARKS RD STE 400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424723",
            "telephone_number": "404-785-3240",
            "fax_number": "404-785-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 MERIDIAN MARKS RD STE 400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424723",
            "telephone_number": "404-785-3240",
            "fax_number": "404-785-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKLE",
        "first_name": "KELLY",
        "credential": "PCNS-BC, PPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-08",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "APRN-NP228738",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN228738",
            "primary": false
        },
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "GA",
            "license": "APRN-CNS228738",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David S Thylur, M.D.
• Sibo Tian, M.D.
• Lina Tibavinsky Bernal, MD
• Christina Tice, CNM
• Tillary Tice, LCSW
• Elizabeth E Tidey
• Ansley Tidwell, PHARMD
• Donna Kay Tidwell
• Ryan Henry Tie-Shue
• Hannah Hinely Tiegreen, LCSW

• Pediatric Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.