KELLIE L SHUCK (PMHNP-CNS, BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1598720534
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KELLIE L SHUCK (PMHNP-CNS, BC)
1001 W Worley St
Columbia, MO 652032037
Phone: (573) 214-2314
Fax: (573) 814-2835
Type: Location
114 W 7TH ST STE 900
AUSTIN, TX 787013013
Phone: (888) 285-2269
Fax: (888) 285-2269
Type: Mailing
1001, West Worley Street, Douglas Park, Columbia, Boone County, Missouri, 65203, United States
COLUMBIA, MO 652032037
Phone: (573) 214-2314
Fax: (573) 814-2835
Type: Mailing
30 HOULTON ST
PATTEN, ME 047653035
Phone: (866) 366-5842
Type: Location
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: 2022-02-02
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 |
|---|---|---|---|---|
| I20130115000382 | I | Certified Clinical Nurse Specialist (Cns) | MO | TBD |
| I20220202002184 | I | Nurse Practitioner | ME | 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 65203)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MO | |
| - | MO | |
| - | MO | |
| - | MO | |
| - | MO | |
| Family Practice | MO | |
| Nurse Practitioner | MO | |
| Geriatric Medicine, Family Practice | MO | |
| - | MO | |
| - | MO |
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