AMANDA MARIE KELLY (FNP) – Nurse Practitioner, NPI 1629668769

AMANDA MARIE KELLY (FNP) is a healthcare provider. based in Crossville, Tennessee. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. APN0000028491 (TN). The NPI Number for AMANDA MARIE KELLY (FNP) is 1629668769

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
AMANDA MARIE KELLY (FNP)
NPI
1629668769
Phone
(931) 787-0155
Address
1846 S MAIN ST
Enumeration Date
22 January 2021
Last Update Date
25 September 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9313030889
Graduation Year
2020 (6 years ago)
PAC ID
4486039187
Group Practice PAC ID
0941683593
Professional Enrollment ID
I20220916000097
Address ID
TN385014150CO920XXAVEX400
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

10,664 NURSE PRACTITIONER in TN

Provider Addresses for AMANDA MARIE KELLY (FNP)

  • 1846 S MAIN ST

    CROSSVILLE, TN 385556188

    Phone: (931) 787-0155

    Type: Location

  • 677 SHADBERRY DR

    CROSSVILLE, TN 385721725

    Phone: (931) 787-0155

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 Open Payments records for all available years, with a total value of $51.

Total Amount is formed as General ($51) + Research ($0) + Ownership ($0) = $51.

Last reported payment date: 2024-11-25 • Largest payer in this snapshot: Alkermes, Inc. ($21).

Total Amount

$51

General + Research + Ownership

Payments

3

Total payment records

General Amount

$51

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-25

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: 2022-09-16

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
I20220916000097INurse PractitionerTNTBD

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 38555)

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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: 0941683593View full group profile
NameSpecialtyState
Nurse PractitionerTN
Nurse PractitionerKY
Family PracticeTN
Internal MedicineAL
Nurse PractitionerTN
Family PracticeTN
Emergency MedicineTN
Mental Health CounselorTN
Nurse PractitionerTN
Nurse PractitionerTN

Reviews

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Frequently asked questions

Is there an official ID for AMANDA MARIE KELLY (FNP) in U.S. healthcare records?
The official identifier for AMANDA MARIE KELLY (FNP) is NPI 1629668769.
Is there an active status for AMANDA MARIE KELLY (FNP)?
For scheduling context, AMANDA MARIE KELLY (FNP) is shown as active in the registry.
What clinical focus is listed for AMANDA MARIE KELLY (FNP)?
At a glance, AMANDA MARIE KELLY (FNP) is tied to Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is AMANDA MARIE KELLY (FNP) associated with Crossville?
Public fields place AMANDA MARIE KELLY (FNP) around Crossville, Tennessee. Always confirm the exact site before visiting.
What does 3 location(s) imply?
3 practice locations appear in the available data.

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