KELLY J LUECK (FNP-C) – Family Medicine Physician, NPI 1578815809
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,379 NURSE PRACTITIONER in OR
Provider Addresses for KELLY J LUECK (FNP-C)
211 EXCHANGE ST
ASTORIA, OR 971031106
Phone: (503) 325-4321
Type: Mailing
3001 DAGGETT AVE STE 101
KLAMATH FALLS, OR 97601
Phone: (541) 274-6564
Type: Location
2946 E BANNER GATEWAY DR
GILBERT, AZ 852342165
Phone: (480) 256-6444
Fax: (480) 256-3682
Type: Location
1201 Pleasant Valley Rd
Owensboro, KY 423039811
Phone: (270) 417-5911
Type: Location
4312 N 7th Ave
Phoenix, AZ 850132903
Phone: (602) 279-5049
Type: Location
PO BOX 6095
BEND, OR 977086095
Phone: (541) 706-5922
Fax: (541) 706-6869
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: 2025-07-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
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 |
|---|---|---|---|---|
| I20130315000103 | I | Nurse Practitioner | AZ | TBD |
| I20170810002684 | I | Nurse Practitioner | OR | TBD |
| I20190709000634 | I | Nurse Practitioner | TX | TBD |
| I20250716001602 | I | Nurse Practitioner | KY | 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 97103)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | KY | |
| - | CA | |
| O T O L A R Y N G O L O G Y | KY | |
| - | KY | |
| O T O L A R Y N G O L O G Y | MO | |
| - | KY | |
| Family Practice | IA | |
| - | KY | |
| Emergency Medicine | KY | |
| - | KY |
Reviews
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