Mary Kathryn Michaelis, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024190998 Issued in VA

Practice address

17068 Lankford Highway
Eastville, VA 23347

Phone

(757) 414-0400

Fax

(757) 414-0569

NPI assigned

Feb 19, 2024

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

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eastern Shore Rural Health System IncorporatedGroup PAC ID 2668380106, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JIBEAA

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.

• Eastern Shore Rural Health System Incorporated

  dba Atlantic Community Health Center

  • Federally Qualified Health Center (FQHC)
  • New Church, VA
  • NPI 1043341613
  Medicare reassignment Care Compare group NPD
• Eastern Shore Rural Health System Incorporated

  dba Atlantic Community Pharmacy

  • Community/Retail Pharmacy
  • Oak Hall, VA
  • NPI 1174224604
  NPD
• Eastern Shore Rural Health System Incorporated

  dba Onley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Onley, VA
  • NPI 1568592426
  NPD
• Eastern Shore Rural Health System Incorporated

  dba Chincoteague Island Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Chincoteague, VA
  • NPI 1598895542
  NPD

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773619200000",
    "number": "1962267997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20280 MARKET ST",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "234171331",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17068 LANKFORD HIGHWAY",
            "city": "EASTVILLE",
            "state": "VA",
            "postal_code": "23347",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20306 Badger Ln",
            "address_purpose": "LOCATION",
            "city": "Onley",
            "state": "VA",
            "postal_code": "234182001",
            "country_code": "US",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5219 Lankford Hwy",
            "address_purpose": "LOCATION",
            "city": "New Church",
            "state": "VA",
            "postal_code": "234153332",
            "country_code": "US",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4049 Main St",
            "address_purpose": "LOCATION",
            "city": "Chincoteague",
            "state": "VA",
            "postal_code": "233362406",
            "country_code": "US",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25228 Lankford Highway",
            "address_purpose": "LOCATION",
            "city": "Onley",
            "state": "VA",
            "postal_code": "23418",
            "country_code": "US",
            "telephone_number": "757-414-0500",
            "fax_number": "757-414-0569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHAELIS",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024190998",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "2023207144",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanette M Grant, DNP, FNP-BC
• Nancy T Hargis, NP
• Julia Annette Johnson Rayfield, DO
• Michelle Jugovich, PA-C
• Nicholas Christopher Lombardozzi, DDS
• Northampton County Board of Supervisors
• Suzanne E Omrod, MSN, RN, ANP-BC
• Emily Patrick, PA
• Linda G Philpot, M.D.
• Rayfield's Pharmacy Inc

• Psychiatric/Mental Health Nurse Practitioner in Eastville, VA
• Providers in Eastville, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.