Kelly Nicole Tullos, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23841 Issued in MS

Practice address

1008 N 15TH Ave
Laurel, MS 39440-2656

Phone

(601) 426-5125

Fax

(601) 426-5126

NPI assigned

May 11, 2012

Last updated

Oct 8, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly Nicole Shoemake Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Central Clinics, IncGroup PAC ID 4385876655, 117 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• South Central Reg Med Ctr Hospital, Laurel, MS, CCN 250058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kshoemake@direct.scrmc.com

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.

• South Central Clinics, Inc

  dba Ellisville Medical Clinic

  • Family Medicine Physician
  • Ellisville, MS
  • NPI 1801226287
  Medicare reassignment Care Compare group NPD
• South Central Clinics, Inc

  dba South Central Urgent Care

  • Rural Health Clinic/Center
  • Laurel, MS
  • NPI 1033903547
  NPD
• South Central Clinics, Inc

  dba South Central General Surgery

  • Surgery Physician
  • Laurel, MS
  • NPI 1154405413
  NPD
• South Central Clinics, Inc.

  dba Ellisville Pediatric Clinic

  • Rural Health Clinic/Center
  • Ellisville, MS
  • NPI 1427098003
  NPD (past)

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

• South Central Regional Medical Center

  • General Acute Care Hospital
  • Laurel, MS
  • NPI 1619973542
  Care Compare affiliation

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791417600000",
    "number": "1508125576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-399-6169",
            "fax_number": "601-399-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 N 15TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402656",
            "telephone_number": "601-426-5125",
            "fax_number": "601-426-5126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "394404243",
            "country_code": "US",
            "telephone_number": "601-428-0577",
            "fax_number": "601-426-9854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TULLOS",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-11",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "23841",
            "primary": true
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "MS",
            "license": "23841",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SHOEMAKE",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Medicine Physician in Laurel, MS
• Providers in Laurel, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.