KIM MCCULLOUGH (F.N.P.) – Family Nurse Practitioner, NPI 1174970487
Family Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KIM MCCULLOUGH (F.N.P.)
1002, Edgewood Drive, Knox, Starke County, Indiana, 46534, United States
KNOX, IN 465348226
Phone: (574) 772-6030
Fax: (574) 772-7494
Type: Mailing
1367 OAKFIELD DR
BRANDON, FL 335114841
Phone: (813) 643-1242
Fax: (813) 643-1246
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-11-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160706000855 | I | Nurse Practitioner | IN | TBD |
| I20221103000178 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46534)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IN | |
| - | IN | |
| Nurse Practitioner | IN | |
| - | UT | |
| Nurse Practitioner | IN | |
| Clinical Social Worker | IN | |
| Family Practice | IN | |
| - | IN | |
| Nurse Practitioner | IN |
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