Individual provider Active NPI

Micah R Kishbaugh, APRN

  • Family Nurse Practitioner
  • Huntington, WV
National Provider Identifier
1548035280
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4009314 Issued in KY
Practice address
2900 1St Ave Ste 230
Huntington, WV 25702-1241
Phone
(304) 525-3711
NPI assigned
Nov 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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 4009314 KY Primary

Addresses

Primary practice location

2900 1St Ave Ste 230
Huntington, WV 25702-1241

Mailing address

1448 10TH Ave Ste 304
Huntington, WV 25701-3579

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address micah.kishbaugh@smmm.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, WV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240328003044 KY Practitioner - Nurse Practitioner 6002253895 Reassigns benefits to 1 organization
I20260327002130 WV Practitioner - Nurse Practitioner 6002253895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Mary'S Medical Management, LLCGroup PAC ID 5890897151, 92 clinicians

Practice addresses (Care Compare)

2828 1St Ave
Huntington, WV 25702-1241

2900 1St Ave
Huntington, WV 25702-1241

Hospital & facility affiliations

  • St Marys Medical Center Hospital, Huntington, WV, CCN 510007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4009314KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Rehab Consultants PLLC Family CurrentSince Mar 17, 2025 Accepting new patients
St. Mary'S Medical Management, LLC Past Accepting new patients

Locations

415 W Golf Rd
Ste 26
Arlington Hts, IL 60005

10250 US Highway 42
Union, KY 41091
Phone (502) 525-6511

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1700611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1548035280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1448 10TH AVE STE 304",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 1ST AVE STE 230",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257021241",
            "telephone_number": "304-525-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHBAUGH",
        "first_name": "MICAH",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4009314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "micah.kishbaugh@smmm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2900 1st Ave Ste 230",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257021241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.