Kellie L Shuck, PMHNP-CNS, BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP211623 Issued in ME

Practice address

30 Houlton St
Patten, ME 04765-3035

Phone

(866) 366-5842

NPI assigned

Apr 20, 2006

Last updated

Feb 10, 2022By 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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO, ME2 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Compass Health, Inc

  dba Compass Health Network

  • Community/Behavioral Health Agency
  • Clinton, MO
  • NPI 1285619494
  Medicare reassignment NPD
• John Fitzgibbon Memorial Hospital Inc

  dba Marshall Family Practice

  • Clinic/Center
  • Marshall, MO
  • NPI 1093731986
  Medicare reassignment NPD
• Rediscover

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lee's Summit, MO
  • NPI 1841235298
  Medicare reassignment NPD
• Moniteau Mental Health Care

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • California, MO
  • NPI 1780848747
  NPD (past) Authorized official
• Katahdin Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Houlton, ME
  • NPI 1376618546
  NPD
• Compass Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1558258632
  NPD
• John Fitzgibbon Memorial Hospital Inc

  dba Fitzgibbon Mental Health

  • Psychiatry Physician
  • Marshall, MO
  • NPI 1285779330
  NPD
• John Fitzgibbon Memorial Hospital Inc.

  dba Fitzgibbon Hospital

  • General Acute Care Hospital
  • Marshall, MO
  • NPI 1730182478
  NPD
• John Fitzgibbon Memorial Hospital, Inc.

  dba Marshall Womens Center

  • Clinic/Center
  • Marshall, MO
  • NPI 1437175320
  NPD
• Rediscover

  • Methadone Clinic
  • Kansas City, MO
  • NPI 1659749414
  NPD
• Dancing Horizon Health LC

  • Medical Specialty Clinic/Center
  • Boonville, MO
  • NPI 1346308749
  NPD (past)
• Share

  dba Dancing Horizon Family Health

  • Voluntary or Charitable Agency
  • Springfield, MO
  • NPI 1972704815
  NPD (past)

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1598720534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W 7TH ST STE 900",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787013013",
            "telephone_number": "888-285-2269",
            "fax_number": "888-285-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HOULTON ST",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047653035",
            "telephone_number": "866-366-5842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 W Worley St",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652032037",
            "country_code": "US",
            "telephone_number": "573-214-2314",
            "fax_number": "573-814-2835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUCK",
        "first_name": "KELLIE",
        "middle_name": "L",
        "credential": "PMHNP-CNS, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "CNP211623",
            "primary": true
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2000161947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427531801",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Joseph Rhatigan, ARNP
• Randall S Roberts
• Kimberly Iverne Rodriguez, CRMA
• Rose M Fuchs (Cornerstone Family Practice)
• Windy M Scott, CNA
• Kimberli Skinner, M.A.
• Amber D Sloat, RN
• Christina A Stadig, RN
• Allison Thibodeau
• Michael J Thibodeau, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Patten, ME
• Providers in Patten, ME by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.