Individual provider Active NPI

Riley Nicole McKuin, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Poplar Bluff, MO
National Provider Identifier
1831821420
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2022028517 Issued in MO
Practice address
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone
(573) 776-2000
Fax
(573) 686-8210
NPI assigned
Jun 30, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2022010858 MO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2022028517 MO Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 2018021822 MO

Addresses

Primary practice location

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573

Mailing address

210 Ruth Harris LN
Poplar Bluff, MO 63901-2206
Phone (573) 300-8117

Other names 1

  • Riley Nicole Greenwall Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20220916001630 MO Practitioner - Nurse Practitioner 9739564469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poplar Bluff Hma Physician Management, LLCGroup PAC ID 5092769703, 41 clinicians

Practice addresses (Care Compare)

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone (573) 727-2773

3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone (855) 444-7276

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 776-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.41 of 100Reported as apm
Quality
79.26
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022010858MOMDPsychiatric/Mental Health Nurse Practitioner
2022028517MOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poplar Bluff Hma Physician Management, LLC CurrentSince Sep 15, 2022 Accepting new patients

Locations

3098 Oak Grove Rd
Poplar Bluff, MO 63901
Phone (573) 778-2600

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

Organizations & group practices 1

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": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1831821420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 RUTH HARRIS LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012206",
            "telephone_number": "573-300-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-776-2000",
            "fax_number": "573-686-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKUIN",
        "first_name": "RILEY",
        "middle_name": "NICOLE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022010858",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022028517",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2018021822",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RILEY",
            "last_name": "GREENWALL",
            "middle_name": "NICOLE",
            "credential": "PMHNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.