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NPI Code Detail

MEDICARE: KELLIE L SHUCK PMHNP-CNS, BC

MEDICARE: KELLIE L SHUCK PMHNP-CNS, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist2000161947MO
2363LP0808XPsychiatric/Mental Health Nurse PractitionerCNP211623ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598720534
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE L SHUCK PMHNP-CNS, BC
Provider Business Mailing Address
First Line : 114 W 7TH ST STE 900
Second Line :
City : AUSTIN
State : TX
Zip : 78701-3013
Country : US
Telephone Number : 888-285-2269
Fax Number : 888-285-2269
Provider Business Practice Location Address
First Line : 30 HOULTON ST
Second Line :
City : PATTEN
State : ME
Zip : 04765-3035
Country : US
Telephone Number : 866-366-5842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 02/10/2022

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