Kelly Reid, APRN-CNP
Individual provider Active NPI Nurse Practitioner · Ada, OK
NPI 1982995791 · NPPES record last updated May 21, 2014
Key facts
- NPI
- 1982995791
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 60112 (OK)
- Practice address
- 1921 Stonecipher Dr
Ada, OK 74820-3439 - Phone
- (580) 436-3980
- Fax
- (580) 272-1026
- NPI assigned
- Apr 27, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pine Ridge Indian Health Service Hospital
Pine Ridge Indian Health Service Hospital
Pine Ridge Indian Health Service Hospital
Practice addresses (Care Compare)
1000 Health Ctr Rd
Kyle, SD 57752-0540
Phone (604) 455-2451
210 E 1St St
Wanblee, SD 57577-0290
Phone (605) 462-6155
East Hwy 18
Pine Ridge, SD 57770-1201
Phone (605) 867-3032
P O Box
Suite 1201
Pine Ridge, SD 57770-1201
P O Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201
PO Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201
Hospital & facility affiliations
- Pine Ridge IHS Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110601000255 | TX | Practitioner - Nurse Practitioner | 9537346408 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Current |
Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current |
Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 60112 | OK | Yes |
Addresses
Primary practice location
1921 Stonecipher Dr
Ada, OK 74820-3439
Mailing address
1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60112 | Other | OK | LICENSE |
Other names
- Kelly Middleton
Other providers in Ada, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.