JACK IRVIN KILLMAN (PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1124887534

JACK IRVIN KILLMAN (PMHNP-BC) is a healthcare provider. based in Bowling green, Kentucky. specializing in NURSE PRACTITIONER. They hold the professional credentials PMHNP-BC. They hold a License No. 35865 (TN). The NPI Number for JACK IRVIN KILLMAN (PMHNP-BC) is 1124887534

Main info

Male
Sole Proprietor
3 Years Of Experience
Accepts Medicare Assignment
Name
JACK IRVIN KILLMAN (PMHNP-BC)
NPI
1124887534
Phone
(270) 205-4585
Address
1048 ASHLEY ST STE 201
Enumeration Date
18 March 2024
Last Update Date
12 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2702054585
Graduation Year
2023 (3 years ago)
PAC ID
3072059849
Group Practice PAC ID
1254491012
Professional Enrollment ID
I20250725004067
Address ID
KY421032449BO1048XSTXX304
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness85
Years active:2State licenses:1Digital endpointsOther names

7,343 NURSE PRACTITIONER in KY

Provider Addresses for JACK IRVIN KILLMAN (PMHNP-BC)

  • 1048 ASHLEY ST STE 201

    BOWLING GREEN, KY 421032449

    Phone: (270) 205-4585

    Fax: (270) 867-0024

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $83.

Total Amount is formed as General ($83) + Research ($0) + Ownership ($0) = $83.

Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Neurocrine BioSciences Inc. ($35).

Total Amount

$83

General + Research + Ownership

Payments

4

Total payment records

General Amount

$83

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2025-07-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250725004067INurse PractitionerKYTBD

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.

Verify on CMS Revalidation Lookup Tool

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 42103)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254491012View full group profile
NameSpecialtyState
Clinical Social WorkerTN
Nurse PractitionerTN
Clinical Social WorkerTN
P S Y C H I A T R YAL
P S Y C H I A T R YSC
Nurse PractitionerTN
-NJ
Nurse PractitionerAL
-AL
-AL

Reviews

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Frequently asked questions

What identifier follows JACK IRVIN KILLMAN (PMHNP-BC) across health systems?
The NPI 1124887534 uniquely identifies JACK IRVIN KILLMAN (PMHNP-BC) in U.S. healthcare data.
Is JACK IRVIN KILLMAN (PMHNP-BC)'s NPI status active today?
Active status means JACK IRVIN KILLMAN (PMHNP-BC)'s NPI record is not deactivated in the public file.
What type of care does JACK IRVIN KILLMAN (PMHNP-BC) provide?
JACK IRVIN KILLMAN (PMHNP-BC)'s profile centers on Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What geographic area is tied to JACK IRVIN KILLMAN (PMHNP-BC)?
JACK IRVIN KILLMAN (PMHNP-BC) is associated with Bowling Green, Kentucky in the same public data insurers reference.
Who maintains JACK IRVIN KILLMAN (PMHNP-BC)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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