KYLIE NELSON – Optometrist, NPI 1962143180

KYLIE NELSON is a healthcare provider. based in Springfield, Missouri. specializing in OPTOMETRY. They hold a License No. 2022026133 (MO). The NPI Number for KYLIE NELSON is 1962143180

Main info

Female
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
KYLIE NELSON
NPI
1962143180
Phone
(662) 641-2109
Address
2436 E Loren St
Enumeration Date
3 April 2022
Last Update Date
10 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8046424339
Graduation Year
2022 (4 years ago)
PAC ID
1254867708
Group Practice PAC ID
3072770932
Professional Enrollment ID
I20241209000737
Address ID
SC298035884AI1055XAXXX500
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience46
Completeness85
Years active:4State licenses:2Digital endpointsOther names

863 OPTOMETRY in MO

Provider Addresses for KYLIE NELSON

  • 2436 E Loren St

    Springfield, MO 658040419

    Phone: (662) 641-2109

    Type: Location

  • 1850 W REPUBLIC RD

    SPRINGFIELD, MO 658075730

    Phone: (417) 891-4920

    Fax: (417) 891-4922

    Type: Mailing

  • 3521 RICHLAND AVE

    AIKEN, SC 298016311

    Phone: (836) 414-4646

    Fax: (803) 641-4648

    Type: Mailing

  • 1518 E BATTLEFIELD RD

    SPRINGFIELD, MO 658043704

    Phone: (417) 881-5530

    Fax: (417) 889-4071

    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: 2024-12-09

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
I20241209000737IOptometrySCTBD

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 65804)

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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: 3072770932View full group profile
NameSpecialtyState
O P T O M E T R YMA
O P T O M E T R YCA
O P T O M E T R YGA
O P T O M E T R YGA
O P T O M E T R YFL
O P T O M E T R YVA
-GA
-GA
O P T O M E T R YSC

Reviews

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Frequently asked questions

Can I verify KYLIE NELSON with an NPI only?
You can start verification with NPI 1962143180 for KYLIE NELSON, then check state licensing separately.
Is KYLIE NELSON still practicing?
KYLIE NELSON is currently listed as active in the public NPI registry.
What is KYLIE NELSON's specialty?
The listing groups KYLIE NELSON with Optometrist. Clinical services aligned with this taxonomy classification.
What address line appears for KYLIE NELSON?
KYLIE NELSON's geographic hint is Springfield, Missouri in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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