KELLY MARIE PLASTER – Nurse Practitioner, NPI 1275341562

KELLY MARIE PLASTER is a healthcare provider. based in Pulaski, Tennessee. specializing in FAMILY PRACTICE. They hold a License No. APN37834 (TN). The NPI Number for KELLY MARIE PLASTER is 1275341562

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
KELLY MARIE PLASTER
NPI
1275341562
Phone
(931) 363-2925
Address
PO BOX 907
Enumeration Date
19 December 2024
Last Update Date
19 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9313632925
Graduation Year
2024 (2 years ago)
PAC ID
2466972252
Group Practice PAC ID
4880728286
Professional Enrollment ID
I20250224002495
Address ID
TN384784519PU1150XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

2,210 FAMILY PRACTICE in TN

Provider Addresses for KELLY MARIE PLASTER

  • PO BOX 907

    PULASKI, TN 384780907

    Phone: (931) 363-2925

    Type: Mailing

  • 1150 E COLLEGE ST

    PULASKI, TN 384784519

    Phone: (931) 363-9568

    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: 2025-02-24

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
I20250224002495IFamily PracticeTNTBD

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 38478)

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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: 4880728286View full group profile
NameSpecialtyState
Nurse PractitionerTN
Family PracticeTN
-TN
Nurse PractitionerTN

Reviews

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Frequently asked questions

What is the 10-digit NPI for KELLY MARIE PLASTER?
KELLY MARIE PLASTER — NPI 1275341562 — is the standard way to identify this listing.
Does CMS list KELLY MARIE PLASTER as active?
Yes — KELLY MARIE PLASTER is active in the NPI listing used on this page.
What taxonomy line describes KELLY MARIE PLASTER?
For research purposes, treat KELLY MARIE PLASTER as Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for KELLY MARIE PLASTER?
KELLY MARIE PLASTER's geographic hint is Pulaski, Tennessee in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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