Kristen Michelle McCormack

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-141418 Issued in AL

Practice address

616 Chaffee St
Talladega, AL 35160-2809

Phone

(256) 362-4197

NPI assigned

Apr 22, 2022

Last updated

Jan 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 AL

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

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25773/brand/1/csg/1/fhir/r4

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.

• Primary Care Select LLC

  • Primary Care Clinic/Center
  • Montgomery, AL
  • NPI 1083375414
  Medicare reassignment NPD

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1982348355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PERRY HILL RD STE 575",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361093630",
            "telephone_number": "334-546-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 CHAFFEE ST",
            "city": "TALLADEGA",
            "state": "AL",
            "postal_code": "351602809",
            "telephone_number": "256-362-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "KRISTEN",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-141418",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-141418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Lessa, MD
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• Candace Lovelace
• Jennifer Norwood Luty, NCC
• Jessica Massey, C.R.N.P
• Amos Troy McGalliard, R.N.
• Mary Page H McKinney, CRNP
• Rachael Blaz Meier, CRNP, FNP-C
• Mending Hearts Counseling Services of Central Alabama, LLC
• Merit Health Care, PC

• Family Nurse Practitioner in Talladega, AL
• Providers in Talladega, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.