Caitlin Marie Kelly, AG-ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704299955 Issued in MI

Practice address

29001 Harper Ave
Saint Clair Shores, MI 48081-2711

Phone

(586) 778-0664

Fax

(586) 778-0396

NPI assigned

Nov 8, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Caitlin Marie Sheardy Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Locations

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.

• Kidney Care Specialists of Michigan PC

  • Nephrology Physician
  • Saint Clair Shores, MI
  • NPI 1588960298
  Medicare reassignment NPD

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1629581970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30025 CHAMPINE ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821653",
            "telephone_number": "586-504-0296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29001 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812711",
            "telephone_number": "586-778-0664",
            "fax_number": "586-778-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CAITLIN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704299955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAITLIN",
            "last_name": "SHEARDY",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "AG-ACNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Irene Kearney
• Chree Selina Louise Kearse
• Thelonious Kee II
• Keith R Hoffmann MD PLC
• Kelly L Zalewski LMSW LLC
• Jordan Marie Kelly
• Whitney Kelly
• Kelsey Ryan LMSW LLC
• Andrew Michael Keltz, M.S.
• Erin Kennedy, OTR

• Acute Care Nurse Practitioner in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.